A 61-year-old man presented with coma and left hemiparesis, He was found to
have tonic downward and inward deviation of the right eye, and a right lat
eral gaze palsy, He also had occasional downward bobbing movements of the r
ight eye, and a partial bilateral upgaze paresis, CT showed a right pontine
tegmental hemorrhage extending to the ipsilateral midbrain, Tonic ocular d
ownward a nd inward deviation associated with pontine tegmental hemorrhage
may be due to irritation of mesencephalic downgaze and convergence centers
by rostral extension of the hematoma. Although 'eyes seeming to peer at the
tip of the nose' is characteristic of thalamic hemorrhage, it may also be
seen secondary to pontine tegmental hemorrhage,
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