Prenuclear Paresis of Homolateral Inferior Rectus and Contralateral Superior Oblique Eye Muscles

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Abstract
• In a case of left inferior rectus paresis, it is demonstrated that the lesion must be prenuclear. On downward gaze, the left eye, although it reached the required target with a rapid saccade, drifted back towards the midline immediately afterwards. During the drift, several corrective saccades appeared. A dissociated "gaze paretic" nystagmus resulted. Synchronously, the right eye showed an incyclorotary nystagmus. We suspect a lesion of "tonic" fibers supplying the nuclear region of the left inferior rectus and the right superior oblique muscle.