Two Cases of Acute Esotropia in Contralateral Thalamic Hemorrhage

J Korean Neurol Assoc > Volume 17(5); 1999 > Article

Journal of the Korean Neurological Association 1999;17(5): 710-712.

시상출혈에서 발생한 대측성 안구의 급성 내사위 2예

이종호, 구본대 ·이계훈 ·허허경

포천중문의과대학교 분당차병원 신경과

Two Cases of Acute Esotropia in Contralateral Thalamic Hemorrhage

Jong-Ho Lee, M.D., Bon-Dae Ku, M.D., Kay-Hoon Lee, M.D., Kyoung Heo, M.D.

Department of Neurology, Pocheon CHA University College of Medicine

Abstract

Monocular gaze palsies which result from a supranuclear cerebral lesion are rare clinical manifestations. The pre-frontal cortico-oculomotor pathways travel across the thalamus and mesodiencephalic junction terminating directly in oculomotor complexes. These pathways exist bilaterally and the contralateral oculomotor bundle exerts an inhibitory influence upon the oculomotor neurons, particularly those related to the medial rectus muscle. The acute disinhibition of these neurons by a posterior thalamic lesion results in a sustained but transient discharge of the medial rectus and tonic activation. Impairment of monocular projections in the contralateral posterior thalamus could result in a tonic activation of the medial rectus, analogous to the conjugate gaze deviation observed with a frontal lobe lesion. We describe two patients with an acute onset of esotropia and contralateral supranuclear lesions - thalamic hemorrhages. J Kor Neurol Ass 17(5):710~712, 1999 Key Words : Esotropia, Thalamus, Intracranial Hemorrhage, Supranuclear palsy