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Ocular lateropulsion refers to directional bias of eye motion toward (ipsipulsion) or away from (contrapulsion) the lesion without limitation of eye motion.1,2⇓ In contrapulsion, the eyes deviate away from the side of the lesion.2,3⇓ Horizontal saccades toward the lesion side usually undershoot the target while saccades away from the side of the lesion overshoot the target.
Medial medullary infarction (MMI) is characterized by a triad of contralesional hemiparesis, decreased position and vibration sensation in the contralateral side of the body, and ipsilesional tongue paralysis.3 We report ocular contrapulsion in a patient with rostral MMI.
Case report.
A 60-year-old man with a history of hypertension and diabetes presented with right-sided weakness and dysarthria. He showed rightward head tilt (figure, A), left beating nystagmus in the primary position, upbeating nystagmus in upward gaze, and ocular lateropulsion to the right (figure, C and D, and the video [available on the Neurology Web site at www.neurology.org]). Both eyes were orthotropic. He had right central type facial palsy and dysarthria. The tongue deviated to the right on protrusion (see figure, A). He also had right hemiparesis. The vibration and position sensation was impaired in the right side. Deep tendon reflexes were decreased bilaterally with positive Babinski sign in the right. He fell to the right on standing.
Figure. (A) Photography of the head and both fundi of the patient. The patient shows rightward …
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