Abstract
A 67-year-old woman, who complained of paralysis of right eye movement and ataxia was described. Neurological examination showed complete palsy of right oculomotor nerve, paralysis of upward movement of the left eye. conjugate gaze was possible, and doll's head eye phenomenon and Bell's phenomenon were not elicited; bilateral cerebellar ataxia which was predominantly on the left side more than on the right side; mild consciousness disturbance, disorientation and hallucinations; mild paralysis of the left upper extremity in the first stage. CT and MRI studies revealed infarction in the midbrain tegmentum extended to the right side of the medial thalamus.
The association of unilateral oculomotor palsy, and bilateral ataxia and disturbed upward gaze of contralateral side referred to as Nothnagel syndrome. And clinical features of our case was consistent with those of Nothnagel syndrome.
We concluded that these neurological findings were caused by the vascular lesion of the right oculomotor nucleus, the decussation of the superior cerebellar peduncle, reticular formation of the midbrain, and thalamus.
