This paper presents a case of thalamic haemorrhage and discusses clinical findings, providing valuable insight into signs clinicians need to look for. The case presented is of a 76-year-old female who developed left hemiplegia and hemi anaesthesia. Ocular motility testing revealed ‘peering at the tip of the nose’ sign which presented as tonic downward deviation of both eyes and esodeviation of the left eye, with no up gaze beyond midline and abduction deficits bilaterally. Bilateral ptosis was also present. It is important for clinicians to be aware of this sign which is thought to reflect damage to the mesodiencephalic junction, so a rapid diagnosis can be reached. Thalamic stroke may also cause further neuro-ophthalmological defects such as homonymous field defects, visual neglect and pupillary abnormalities, which will vary depending on the location of the lesion.

‘Peering at the tip of the nose’ as a sign of thalamic haemorrhage.
Ahmad K, Kumar K.
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Claire Howard

Salford Royal NHS Foundation Trust, Salford, UK.

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