BLEPHAROPTOSIS IN ASSOCIATION WITH IPSILATERAL ADDUCTION AND ELEVATION PALSY - A FORM OF FASCICULAR OCULOMOTOR PALSY

A 16-year-old girl hospitalized with a sudden onset of blepharoptosis and diplopia revealed a combined paresis of the elevator palpebrae, th e superior rectus, and the medial rectus muscles of the left eye as qu antitatively demonstrated by the Hess chart and levator action test. A small midbrain lesion confined to the left cerebral peduncle and tegm entum, presumably by an ischemic or demyelinative process, was identif ied on magnetic resonance imaging. Despite uncertainty in its patholog y, the incomplete oculomotor palsy of this case is certainly a consequ ence of oculomotor fascicular involvement in the intra-axial nerve roo t which initially fans out and then converges into the peripheral comp act bundle. We speculate on the revised version of the oculomotor fasc icular arrangements by which the neurophthalmologic features of the cu rrent case are better explained.