Features Of Ocular Motor Abnormality In Early Stage Of Brain Stem Infarction

Shihui WEI

Ophthalmology Department, General Hospital of CPLA, Beijing, China

Purpose: To investigate the characteristics of ocular motor abnormality in the early stage of brain stem infarction, and evaluate their value in the early diagnosis.

Methods: A total of 24 patients (19 males, 5 females) with initial diplopia were chosen from 287 patients with brain stem infarction. The mean age was 64 (range, 42-81). Their clinical features, accompanied symptom and related examination were retrospectively analyzed.

Results: The risk factors included hypertension in 20 cases (83. 3%), coronary heart disease in 9 cases (37.5%), diabetes mellitus in 7 cases (29.12%), atrial fibrillation in 3 cases (12.5%). About 87.5% patients complained with dizziness, and 16.7% with nausea, 16.7% with limb ataxia, 8.3% with vertigo, 4.2% with limb weak. The infarcts of 9 patients (37. 5%) were located in midbrain, 14 patients (58. 3%) in pons and 1 patient (4. 2%) in medulla. Nuclear oculomotor nerve palsies were seen in the midbrain infarction, in which medial rectus weakness (8 cases) was dominant compared with other ocular muscles. The oculomotor disturbances of pons infarction were various, which included internuclear ophthalmoplegia in 3 cases, the abduct nerve palsy in 3 cases, the oculomotor nerve palsy in 2 cases, the para-Horner syndrome in 1 case, and nystagmus in 10 cases.

Conclusions: In brain stem infarction, the main characters of ocular motor abnormality include nuclear ophthalmoplegia, internuclear ophthalmoplegia and nystagmus, which play an important role in the early diagnosis.