Midbrain Infarction Or Bleeding

This can lead to an acute onset of 

  • vertical gaze palsy (due to an impaired function of the Rostral Interstitial Nucleus of the Medial Longitudinal fascicle (riMLF), 
  • isolated vertical gaze evoked nystagmus(due to an impaired function of the Interstitial Nucleus of Cajal (INC)
  • convergence retraction nystagmus (due to an impaired function of the the posterior commissure and or bilateral lesion of the riMLF) and/or 
  • ocular tilt reaction (contraversive to the side of the lesion) with or without a skew deviation

Reference

Balami JS, et al. (2013) Stroke syndromes and clinical management. QJM 106(7):607-615. PubMed