Abstract
Two patients presenting supranuclear gaze palsy with thalamomesencephalic vascular lesions were reported on. One developed bilateral exotropia in the primary position. CT and MRI scans revealed bilateral thalamic infarction caused by occlusion of the paramedian thalamic arteries. He was unable to adduct both eyes in the lateral gaze, although adduction palsy could be overcome by covering the contralateral eye. The vertical gaze was remarkably restricted. The other patient showed right thalamic hemorrhage with vertical gaze limitation and weakness of abduction in the left eye. The limitation of abduction, how-ever, could be overcome by covering the right eye and through caloric stimulation. It is postulated that the present cases of supranuclear horizontal gaze palsy were due to the interruption of cortico-bulber pathways to the paramedian pontine reticular formation (PPRF), or output from the PPRF to control horizontal gaze passing near the thalamic lesion extending to the rostral part of the mesencephalon.
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