A 61-year-old man presented with coma and left hemiparesis. He was found to have tonic downward and inward deviation of the right eye, and a right lateral gaze palsy. He also had occasional downward bobbing movements of the right eye, and a partial bilateral upgaze paresis. CT showed a right pontine tegmental hemorrhage extending to the ipsilateral midbrain. Tonic ocular downward and inward deviation associated with pontine tegmental hemorrhage may be due to irritation of mesencephalic downgaze and convergence centers by rostral extension of the hematoma. Although ‘eyes seeming to peer at the tip of the nose’ is characteristic of thalamic hemorrhage, it may also be seen secondary to pontine tegmental hemorrhage.

1.
Fisher CM: The pathologic and clinical aspects of thalamic hemorrhage. Trans Am Neurol Assoc 1959;84:56–59.
2.
Chung CS, Caplan LR, Han W, Pessin MS, Lee KH, Kim JM: Thalamic haemorrhage. Brain 1996;119:1873–1886.
3.
Caplan LR, Goodwin JA: Lateral tegmental brainstem hemorrhages. Neurology 1982;32:252–260.
4.
Zee DS: Supranuclear and internuclear ocular motor disorders; in Miller NR, Newman NJ (eds): Walsh and Hoyt’s Clinical Neuro-Ophthalmology, ed 5. Baltimore, Williams & Wilkins, 1998, vol 1, pp 1283–1349.
5.
Gomez CR, Gomez SM, Selhorst JB: Acute thalamic esotropia. Neurology 1988;38:1759–1762.
6.
Sharpe JA: Neural control of ocular motor systems; in Miller NR, Newman NJ (eds): Walsh and Hoyt’s Clinical Neuro-Ophthalmology, ed 5. Baltimore, Williams & Wilkins, 1998, vol 1, pp 1101–1188.
7.
Pierrot-Deseilligny C, Chain F, Gray F, Serdaru M, Escourolle R, Lhermitte F: Parinaud’s syndrome: Electro-oculographic and anatomical analyses of six vascular cases with deductions about vertical gaze organization in the premotor structures. Brain 1982;105:667–696.
8.
Brandt T, Dietrich M: Vestibular syndromes in the roll plane: Topographic diagnosis from brainstem to cortex. Ann Neurol 1994;36:337–347.
9.
Bogousslavsky J, Regli F: Convergence and divergence synkinesis. A recovery pattern in benign pontine hematoma. Neuroophthalmology 1984;4:219–225.
10.
Leigh RJ, Zee DS: The Neurology of Eye Movements. Philadelphia, Davis, 1991, pp 195–231.
11.
Larmande P, Henin D, Jan M, Elie A, Gouaze A: Abnormal vertical eye movements in the locked-in syndrome. Ann Neurol 1982;11:100–102.
12.
Christoff N: A clinicopathologic study of vertical eye movements. Arch Neurol 1974;31:1–8.
13.
Dominguez RO, Bronstein AM: Complete gaze palsy in pontine haemorrhage. J Neurol Neurosurg Psychiatry 1988;51:150–151.
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