Rinsho Shinkeigaku (Clinical Neurology)

Case Report

A case of oculomotor disorder and urinary retention due to a lower midbrain lesion

Makoto Sainouchi, M.D.1)2), Michikazu Nakamura, M.D., Ph.D.1)3), Yuichi Masuda, M.D.1)4) and Ryo Ohtani, M.D., Ph.D.1)

1) Department of Neurology, National Hospital Organization Kyoto Medical Center
2) Present Address: Department of Pathology, Brain Research Institute, Niigata University
3) Present Address: Department of Neurology, Amagasaki Daimotsu Hospital
4) Present Address: Department of Internal Medicine IV, Division of Neurology, Osaka Medical College

We report an 86-year-old woman who suffered sudden onset of diplopia while cooking. The patient presented with binocular diplopia, bilateral adduction weakness, convergence disorder and bilateral abduction nystagmus. Although brain MRI on admission detected no abnormality, a repeat MRI examination on the following day demonstrated a focal hyperintense lesion in the tegmentum of the midbrain on diffusion-weighted images. At 36 hours after admission, lower abdominal distension became apparent, and about 1 liter of urine was drained via a urethral catheter. Bladder filling sensation was not present, and we considered that the midbrain lesion had been responsible for the oculomotor disorder and urinary retention. As cerebral infarction was the most likely pathology of this lesion, an antiplatelet agent was administered. At two months after onset, the eye movement disorder was resolved and there was no diplopia. Bladder voiding also resumed at normal intervals. We considered that the bilateral medial longitudinal fasciculi and subgroups of the oculomotor nucleus, which contain motor neurons supplying the medial rectus muscle, had been responsible for the oculomotor disorder. The urinary retention was thought to have been caused by a lesion in the periaqueductal gray, which is one structure controlling micturition. This was a rare case of urinary retention due to a small midbrain infarction.
Full Text of this Article in Japanese PDF (2643K) @@@@ Full Text of this Article in English HTML

(CLINICA NEUROL, 61: 24|28, 2021)
key words: urinary retention, oculomotor disorder, MLF syndrome, periaqueductal gray, midbrain infarction

(Received: 29-May-20)