J Korean Ophthalmol Soc.  2014 Nov;55(11):1714-1720. 10.3341/jkos.2014.55.11.1714.

A Case of Double Depressor Palsy due to Bilateral Thalamic Infarction

Affiliations
  • 1Department of Ophthalmology, Maryknoll Medical Center, Busan, Korea. pearlsj@hanmail.net
  • 2Department of Ophthalmology, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea.

Abstract

PURPOSE
We report a rare case of double depressor palsy after bilateral thalamus infarction. CASE SUMMARY: A 47-year-old male presented with complaints of diplopia upon awakening. He had atrial fibrillation, mitral valve regurgitation, aortic valve regurgitation and a history of spleen infarction 1 year prior. His right eye was hypertrophic and right eye downgaze was limited unilaterally of equal degree in adduction and abduction. Right eye horizontal and upward movements were intact. Left eye movement was intact in all directions. Pupillary light reflex response and convergence test were normal. Nystagmus was not observed. The patient was diagnosed with double depressor palsy of the right eye. Magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) of the brain showed an old infarction of the left thalamus and diffusion MRI showed acute infarction of the right thalamus. The patient's daily warfarin dose was 2 mg and was increased to 5 mg with cilostazol 75 mg two times a day. Seven weeks later, the patient's ocular movement revealed near normal muscle action and, subjectively, the patient was diplopia-free.
CONCLUSIONS
Double depressor palsy is a extremely rare disease and can be caused by bilateral thalamic infarction.

Keyword

Bilateral paramedian thalamus infarction; Double depression palsy; Monocular depression palsy

MeSH Terms

Aortic Valve
Atrial Fibrillation
Brain
Diffusion Magnetic Resonance Imaging
Diplopia
Eye Movements
Humans
Infarction*
Magnetic Resonance Angiography
Magnetic Resonance Imaging
Male
Middle Aged
Mitral Valve Insufficiency
Paralysis*
Rare Diseases
Reflex
Spleen
Thalamus
Warfarin
Warfarin
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