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Isolated paresis of the inferior rectus may be caused by midbrain lesions such as metastasis1 or multiple sclerosis.2 Midbrain infarction is an extremely rare cause of isolated inferior rectus palsy.3,4 We report a patient with isolated inferior rectus palsy due to midbrain infarction probably involving the fascicle. The lesion was detected by diffusion-weighted MRI (DWI).
Case report.
A 56-year-old woman with hypertension and diabetes mellitus suddenly developed lightheadedness and diplopia on looking downward. Four days later, her ocular examination showed isolated inferior rectus palsy of the right eye: limitation of her right eye to the right downward direction and slight hypertropia of the right eye on primary gaze (figure, A). Pupil sizes and light reflexes were normal, and ptosis was absent in both eyes. Head tilting was not observed. On the red glass test, maximally separated images were observed on the right downward gaze, the red image being present inferior to the white one. Otherwise, neurologic examination was normal. MRI examinations were performed with 1.5 Tesla …
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