Monocular Elevation Paresis Caused by a Central Nervous System Lesion

Abstract

Seven patients with acquired monocular elevation paralysis who cannot be included in any known diagnostic formulation are presented. We propose that monocular elevation paresis in these cases can be attributed to a unilateral lesion in the pretectum that involves (1) the supranuclear fibers to the subnucleus of the oculomotor complex which supplies the opposite superior rectus (and when the paralysis is complete, the supranuclear fibers to the inferior oblique) and (2) the pupillary pathways in some patients. The most probable cause is a vascular occlusion of one of the fine blood vessels supplying this area.¹