{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T16:15:10Z","timestamp":1771258510613,"version":"3.50.1"},"reference-count":22,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,2,25]],"date-time":"2021-02-25T00:00:00Z","timestamp":1614211200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2021,2,25]],"date-time":"2021-02-25T00:00:00Z","timestamp":1614211200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Ophthalmol"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Cogan\u2019s anterior internuclear ophthalmoplegia (INO) is characterized by INO with inability to converge and commonly thought to be due to rostral midbrain lesion. A lesion outside midbrain that causes unilateral Cogan\u2019s anterior INO combined with upgaze palsy and ataxia are rarely described.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Case presentation<\/jats:title>\n                <jats:p>A 67-year old male presented with left Cogan\u2019s anterior internuclear ophthalmoplegia (INO), left appendicular ataxia and bilateral upgaze palsy. A Magnetic Resonance Imaging (MRI) and Magnetic Resonance Angiography (MRA) brain showed a left dorsal tegmental infarct at the level of pontomesencephalic junction.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>This case highlights the clinical importance of Cogan\u2019s anterior INO in combination with upgaze palsy and ataxia, and report possible site of lesion in patients with such constellation. Clinicians should consider looking for cerebellar signs in cases of Cogan\u2019s anterior INO, apart from just considering localizing the lesion at the midbrain.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12886-021-01868-9","type":"journal-article","created":{"date-parts":[[2021,2,25]],"date-time":"2021-02-25T13:03:29Z","timestamp":1614258209000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["A rare case of unilateral Cogan\u2019s anterior internuclear ophthalmoplegia, upgaze palsy and ataxia caused by dorsal tegmentum lesion at pontomesencephalic junction"],"prefix":"10.1186","volume":"21","author":[{"given":"Yong Zheng","family":"Wai","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qi Xiong","family":"Ng","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tsu Hong","family":"Lim","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lik Thai","family":"Lim","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,2,25]]},"reference":[{"issue":"9","key":"1868_CR1","doi-asserted-by":"publisher","first-page":"1491","DOI":"10.1212\/01.WNL.0000123093.37069.6D","volume":"62","author":"JS Kim","year":"2004","unstructured":"Kim JS. Internuclear ophthalmoplegia as an isolated or predominant symptom of brainstem infarction. Neurology. 2004;62(9):1491\u20136.","journal-title":"Neurology"},{"key":"1868_CR2","doi-asserted-by":"crossref","unstructured":"Leigh RJ, Zee DS. The Neurology of Eye Movements [Internet]. Oxford, UK: Oxford University Press; 2015. Available from: https:\/\/oxfordmedicine.com\/view\/10.1093\/med\/9780199969289.001.0001\/med-9780199969289.","DOI":"10.1093\/med\/9780199969289.001.0001"},{"key":"1868_CR3","doi-asserted-by":"crossref","unstructured":"Cogan DG. Internuclear ophthalmoplegia, typical and atypical. Arch Ophthalmol (Chicago, Ill 1960). 1970;84(5):583\u20139.","DOI":"10.1001\/archopht.1970.00990040585005"},{"key":"1868_CR4","doi-asserted-by":"crossref","unstructured":"Kupfer C, Cogan DG. Unilateral internuclear ophthalmoplegia. A clinicopathological case report. Arch Ophthalmol (Chicago, Ill 1960). 1966;75(4):484\u20139.","DOI":"10.1001\/archopht.1966.00970050486008"},{"key":"1868_CR5","doi-asserted-by":"crossref","unstructured":"Okuda B, Tachibana H, Sugita M, Maeda Y. Bilateral internuclear ophthalmoplegia, ataxia, and tremor from a midbrain infarction. Vol.\u00a024, Stroke. United States; 1993. p.\u00a0481\u20132.","DOI":"10.1161\/01.STR.24.3.481"},{"key":"1868_CR6","doi-asserted-by":"crossref","unstructured":"Bogousslavsky J, Maeder P, Regli F, Meuli R. Pure midbrain infarction. Neurology [Internet]. 1994 Nov 1;44(11):2032 LP \u2013 2032. Available from: http:\/\/n.neurology.org\/content\/44\/11\/2032.abstract.","DOI":"10.1212\/WNL.44.11.2032"},{"key":"1868_CR7","doi-asserted-by":"publisher","unstructured":"Gelaw Y. Cogan\u2019s anterior internuclear ophthalmoplegia in young Ethiopian: A case report and review of literature. Alexandria J Med [Internet]. 2014;50(4):373\u20136. Available from: https:\/\/doi.org\/10.1016\/j.ajme.2014.05.006.","DOI":"10.1016\/j.ajme.2014.05.006"},{"issue":"3","key":"1868_CR8","doi-asserted-by":"publisher","first-page":"230","DOI":"10.1136\/practneurol-2014-001062","volume":"15","author":"SA Khan","year":"2015","unstructured":"Khan SA, Brooks M, Crompton DE. Large basilar tip aneurysm causing anterior internuclear ophthalmoplegia. Pract Neurol. 2015;15(3):230.","journal-title":"Pract Neurol"},{"issue":"6","key":"1868_CR9","doi-asserted-by":"publisher","first-page":"721","DOI":"10.1111\/ane.12795","volume":"136","author":"L Pollak","year":"2017","unstructured":"Pollak L, Zehavi-Dorin T, Eyal A, Milo R, Huna-Baron R. Parinaud syndrome: Any clinicoradiological correlation? Acta Neurol Scand. 2017;136(6):721\u20136.","journal-title":"Acta Neurol Scand"},{"issue":"11","key":"1868_CR10","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1136\/bcr-2020-238422","volume":"13","author":"Y Yang","year":"2020","unstructured":"Yang Y, Qidwai U, Burton BJL, Canepa C. Bilateral, vertical supranuclear gaze palsy following unilateral midbrain infarct. BMJ Case Rep. 2020;13(11):1\u20135.","journal-title":"BMJ Case Rep"},{"issue":"10","key":"1868_CR11","doi-asserted-by":"publisher","first-page":"1985","DOI":"10.1212\/WNL.54.10.1985","volume":"54","author":"R Bhidayasiri","year":"2000","unstructured":"Bhidayasiri R, Plant GT, Leigh RJ. A hypothetical scheme for the brainstem control of vertical gaze. Neurology. 2000;54(10):1985\u201393.","journal-title":"Neurology"},{"key":"1868_CR12","doi-asserted-by":"crossref","unstructured":"Kurkcuoglu A. Mesencephalon. Midbrain. Hum Anat - Rev Med Adv. 2017.","DOI":"10.5772\/intechopen.68767"},{"key":"1868_CR13","first-page":"1","volume":"2016","author":"AS Haider","year":"2016","unstructured":"Haider AS. Unilateral internuclear ophthalmoplegia, strabismus and transient torsional nystagmus in focal pontine infarction. BMJ Case Rep. 2016;2016:1\u20135.","journal-title":"BMJ Case Rep"},{"issue":"1","key":"1868_CR14","doi-asserted-by":"publisher","first-page":"82","DOI":"10.1152\/jn.1989.62.1.82","volume":"62","author":"PDR Gamlin","year":"1989","unstructured":"Gamlin PDR, Gnadt JW, Mays LE. Lidocaine-induced unilateral internuclear ophthalmoplegia: Effects of convergence and conjugate eye movements. J Neurophysiol. 1989;62(1):82\u201395.","journal-title":"J Neurophysiol"},{"issue":"2","key":"1868_CR15","doi-asserted-by":"publisher","first-page":"149","DOI":"10.1136\/practneurol-2016-001428","volume":"17","author":"JD Virgo","year":"2017","unstructured":"Virgo JD, Plant GT. Internuclear ophthalmoplegia. Pract Neurol. 2017;17(2):149\u201353.","journal-title":"Pract Neurol"},{"key":"1868_CR16","doi-asserted-by":"publisher","unstructured":"Lee SU, Bae HJ, Kim JS. Ipsilesional limb ataxia and truncal ipsipulsion in isolated infarction of the superior cerebellar peduncle. J Neurol Sci [Internet]. 2015;349(1\u20132):251\u20133. Available from: https:\/\/doi.org\/10.1016\/j.jns.2015.01.006.","DOI":"10.1016\/j.jns.2015.01.006"},{"issue":"1","key":"1868_CR17","doi-asserted-by":"publisher","first-page":"248","DOI":"10.3171\/2015.2.JNS142707","volume":"124","author":"K Matsushima","year":"2016","unstructured":"Matsushima K, Yagmurlu K, Kohno M, Rhoton AL. Anatomy and approaches along the cerebellar-brainstem fissures. J Neurosurg. 2016;124(1):248\u201363.","journal-title":"J Neurosurg"},{"issue":"5","key":"1868_CR18","doi-asserted-by":"publisher","first-page":"973","DOI":"10.1007\/s00415-016-8088-1","volume":"263","author":"SU Lee","year":"2016","unstructured":"Lee SU, Kim HJ, Park JJ, Kim JS. Internuclear ophthalmoplegia plus ataxia indicates a dorsomedial tegmental lesion at the pontomesencephalic junction. J Neurol. 2016;263(5):973\u201380.","journal-title":"J Neurol"},{"issue":"6","key":"1868_CR19","doi-asserted-by":"publisher","first-page":"1419","DOI":"10.1007\/s10072-012-0966-4","volume":"33","author":"H Liu","year":"2012","unstructured":"Liu H, Qiao L, He Z. Wernekink commissure syndrome: A rare midbrain syndrome. Neurol Sci. 2012;33(6):1419\u201321.","journal-title":"Neurol Sci"},{"issue":"4","key":"1868_CR20","doi-asserted-by":"publisher","first-page":"346","DOI":"10.1159\/000047733","volume":"12","author":"Y Krespi","year":"2001","unstructured":"Krespi Y, Aykutlu E, \u00c7oban O, Tun\u00e7ay R, Bahar S. Internuclear ophthalmoplegia and cerebellar ataxia: Report of one case. Cerebrovasc Dis. 2001;12(4):346\u20138.","journal-title":"Cerebrovasc Dis"},{"issue":"5","key":"1868_CR21","doi-asserted-by":"publisher","first-page":"1055","DOI":"10.4103\/0028-3886.190299","volume":"64","author":"S Sheetal","year":"2016","unstructured":"Sheetal S, Byju P. Wernekink commissure syndrome. Neurol India. 2016;64(5):1055\u20137.","journal-title":"Neurol India"},{"key":"1868_CR22","doi-asserted-by":"publisher","unstructured":"Zhang Y, Wang L, He M. Isolated INO as a presentation of midbrain paramedian area lacunar infarction in patients with diabetes. J Clin Neurosci [Internet]. 2017;45:261\u20134. Available from: https:\/\/doi.org\/10.1016\/j.jocn.2017.08.005.","DOI":"10.1016\/j.jocn.2017.08.005"}],"container-title":["BMC Ophthalmology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12886-021-01868-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1186\/s12886-021-01868-9\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12886-021-01868-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,2,25]],"date-time":"2021-02-25T13:31:40Z","timestamp":1614259900000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcophthalmol.biomedcentral.com\/articles\/10.1186\/s12886-021-01868-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,2,25]]},"references-count":22,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["1868"],"URL":"https:\/\/doi.org\/10.1186\/s12886-021-01868-9","relation":{},"ISSN":["1471-2415"],"issn-type":[{"value":"1471-2415","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,2,25]]},"assertion":[{"value":"27 November 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 February 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 February 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"This case report is registered under National Medical Research Register (NMRR-20-2515-57304). No ethics approval is needed for this case report after reviewed by the committee of National Medical Research Registry. Written consent was taken from the patient for participation .","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Written informed consent was obtained from the patient for publication of this case report and any accompanying images.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"105"}}