Abstract
Abstract
Brainstem strokes can have protean ophthalmological manifestations including pupillary and extraocular muscle pareses. Incomplete paresis of oculomotor function is more common than complete paresis owing to the selective involvement of subnuclei or fascicles for various extraocular muscles. Here, we report a case of right paramedian midbrain stroke presented with asymmetric bilateral ptosis. We discuss the anatomical correlation of this presentation with the structure of oculomotor nerve nuclei and its fascicles.
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