Sustained downgaze as the only remained sign after regaining consciousness in hepatic encephalopathy

Sustained downgaze mostly occurs in association with lesions affecting the dorsal midbrain. We report sustained downgaze in a patient with hepatic encephalopathy. The sustained downgaze existed for seven more days after she regained her consciousness. The persistent downgaze even after regaining full consciousness indicates localized pretectal dysfunction rather than diffuse encephalopathy as the mechanism of sustained downgaze in our patient. The ocular motor dysfunction in hepatic encephalopathy may be due to localized dysfunction of the brainstem. Neurology Asia 2014; 19(1) : 105 – 106 Address correspondence to: So Young Moon, MD, PhD, Department of Neurology, School of Medicine, Ajou University, San 5, Woncheon-dong, Yeongtonggu, Suwon, Kyungki-do, 443–721, South Korea. Tel: 82-31-219-5175; Fax: 82-31-219-5178; E-mail: [email protected] INTRODUCTION Sustained downgaze mostly occurs in lesions affecting the dorsal midbrain. However, this eye sign has also been reported in subarachnoid hemorrhage, seizure, hepatic failure, hypoglycemia, and hypoxic encephalopathy, even without structural damage to the pretectal area. We report sustained downgaze as the only persistent finding in a patient with hepatic encephalopathy after regaining the consciousness.