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April 1996

Mesencephalic Clefts With Associated Eye Movement Disorders

Author Affiliations

From the Neuro-ophthalmology Service (Drs Lagrèze and Bienfang) and Departments of Radiology (Dr Zamani) and Neurology (Drs Gouras and Koralnik), Harvard Medical School, Brigham and Women's Hospital, Boston, Mass; and Department of Ophthalmology and Neurology, University of Utah, Salt Lake City (Dr Warner).

Arch Ophthalmol. 1996;114(4):429-432. doi:10.1001/archopht.1996.01100130425012

Objective:  To describe two patients with mesencephalic midline clefts and associated eye movement disorders.

Design:  Case reports.

Results:  The first patient developed bilateral internuclear ophthalmoplegia with exotropia, reduced convergence, right ptosis, right fourth-nerve palsy, and right elevator palsy several years after meningitis with hydrocephalus. The second patient had bilateral internuclear ophthalmoplegia with exotropia, reduced convergence, bilateral ptosis, limited upward gaze, and right hypertropia since childhood. In both patients, magnetic resonance imaging showed a midline cleft extending from the cerebral aqueduct into the midbrain.

Conclusion:  It is likely that the clefts affected the oculomotor nuclei and medial longitudinal fasciculi, accounting for the eye movement disorders.

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