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Upward gaze palsy and convergence insufficiency as a rare presentation of primary intraventricular haemorrhage
  1. Jun Tanimura,
  2. Hiromasa Sato,
  3. Masahiro Ebitani and
  4. Takao Hashimoto
  1. Department of Neurology, Aizawa Hospital, Matsumoto, Nagano, Japan
  1. Correspondence to Dr Takao Hashimoto; sinke-dr{at}


A primary intraventricular haemorrhage (PIVH) usually presents with non-localised neurological symptoms since the haematoma is limited to the ventricles. However, it is sometimes associated with focal neurological signs, whose pathophysiologies are not confirmed. Here, we report on a case of PIVH who showed rare manifestations in the acute stage: upward gaze palsy and convergence insufficiency. The CT and MRI showed intraventricular haematoma without evidence of parenchymal haemorrhage, local mass effect around midbrain or hydrocephalus. There had been bilateral papilloedema, and it resolved along with improvement of the ophthalmic symptoms, suggesting a possible causal relation to increased intracranial pressure. The ophthalmic abnormalities suggested injury of the rostral part of the midbrain, especially the region around the dorsal midbrain tectum. It should be known that PIVH is one of the causes of acutely developing upward gaze palsy and convergence insufficiency.

  • neurology
  • stroke
  • neuroopthalmology
  • brain stem / cerebellum

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  • Contributors JT and TH contributed to the clinical care of the patient and drafting/revising the manuscript. HS and ME contributed to revising the manuscript. All authors account for all aspects of the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.