Transient vertical Nystagmus: An unusual presentation of Tha
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Vertical nystagmus is attributed to a disturbance of the anterior semicircular canal projections and typically indicates a structural lesion of the brainstem. The ocular findings are exceedingly rare in thalamic infarction. Here, we describe a patient presenting with vertical diplopia and nystagmus without gaze paresis secondary to isolated medial thalamic infarct.

Case Report: A 19-years old previously healthy male presented with a history of vertical diplopia and nystagmus lasting for an hour duration. He denied vertigo, weakness, paresthesia, or altered level of consciousness. He had no identifiable vascular risk factors or family history of premature cerebrovascular events. On examination, he was oriented with no evidence of language disturbance. Examination of cranial nerves revealed upbeat nystagmus in primary gaze, which intensified on upgaze. Vertical diplopia was reported in all directions of gaze and was more prominent when focusing on distant objects. There was no evidence of ophthalmoplegia and pupils were symmetrical with intact light reflex. A mild ataxic hemiparesis was evident on presentation. His pulse rate was 80 beats per minute, regular and blood pressure was 120/80 mmHg. Remaining systemic examination was unremarkable. A magnetic resonance imaging (MRI) scan of the brain which was performed after the onset of symptoms showed an acute left paramedian thalamic infarct. There were no lesions detected in brainstem or cerebellum. MR angiogram showed intact anterior and posterior circulation. All basic hematological and biochemical investigations including renal and liver profile were normal. The vasculitic and thrombophilic screening was performed and were normal. Cardiac, renal and vascular imaging studies were also normal. Treatment with aspirin and atrovastatin was initiated.
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