Teaching Neuro Images Spontaneous thalamic hemorrhage causing convergence excess

Abstract

A 61-year-old man had acute stupor and left-sided weakness. Head CT showed right thalamic hemorrhage (figure 1, A and B). Regaining consciousness the next day, he had bilateral convergence excess and upward gaze limitation (figure 2) with preserved light and oculocephalic reflexes. The phenomenon disappeared in sleep. The authors thank Chia-Huei Yen, who helped with the illustration of the anatomy.