Nuclear 3rd CN Palsy with Vertical Gaze Palsy

A patient with significant vasculopathy risk factors (DM, HTN, dyslipidemia), had a stroke affecting the right thalamus, midbrain, and right cerebellum due to basilar artery occlusion. He had a successful mechanical thrombectomy with a stent retriever and contact aspiration resulting in recanalization of the top of the basilar and bilateral posterior cerebral artery occlusions. Motility assessment one year after the stroke showed a right complete 3rd cranial nerve palsy with vertical gaze palsy, resulting in a large right exotropia and left hypotropia. This led to a significant left-face turn and chin-up posture. To address this, a surgical intervention involving nasal transposition of the split lateral rectus with plication of the right medial rectus was performed. The procedure resulted in satisfactory alignment in the primary position and a significant improvement in the face turn.

Presentation Date: 03/28/2024

Issue Date: 04/19/2024