Mesencephalic Clefts and Eye Movement Disorders

Abstract

We read with interest the article by Lagreze et al 1 that was published in the April 1996 issue of theArchives. The authors described 2 patients with similar eye movement disorders that they attributed to a midline mesencephalic cleft. This clinicalradiographic association had not been previously reported. We would like to share a similar case. A 67-year-old man had a history of ptosis and diplopia since early adulthood. Photographs from childhood confirmed normal eyelid position and ocular alignment until the age of 18 years. His diplopia required increasing prism diopter (Δ) strength during a 20-year period, but he preferred to use a compensatory head turn. No family members had similar problems. In the past 10 years, a slowly progressive gait ataxia had developed. On neuro-ophthalmic examination, his visual acuity was 20/20 OU and the visual fields were normal. The pupils, anterior segments, and fundi were normal. An external examination