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Wolf-Dietrich A. Lagrèze, MD; Judith E. A. Warner, MD; Amir A. Zamani, MD; Gunnar K. Gouras, MD; Igor Koralnik, MD; Don C. Bienfang, MD

Arch Ophthalmol. 1996;114(4):429-432.

Abstract
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.

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).

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ABSTRACT