Divergence paralysis is defined as having a supranuclear cause with sudden onset of comitant esotropia and uncrossed diplopia at distance, fusion at near (usually 1-2 m) normal ductions and versions, and gross impairment of fusional amplitudes of divergence.
*1. Brainstem lesions
A. Cerebellar cyst
C. Tumors, such as cerebellar and acoustic neuromas and pontine glioma
2. Cerebral hemorrhage
5. Dorsal midbrain syndrome
6. Epidemic encephalitis
8. Head injuries
9. Increased intracranial pressure
11. Lead poisoning
12. Multiple sclerosis (disseminated sclerosis)
16. Vascular disease
A. Diabetes mellitus
C. Occlusion of subclavian artery with reversal of flow in vertebral artery
D. Vertebral basilar insufficiency
Arai M, Fujii S. Divergence paralysis Neurology 1990; 237:45-46.
Brown SM, Iacuone JJ. Intact sensory fusion in a child with divergence paresis caused by a pontine glioma. Am J Ophthalmol 1999; 128:528-530.
Krohel GB, et al. Divergence paralysis. Am J Ophthalmol 1982; 94:506.
Walsh FB, Hoyt WF. Clinical neuro-ophthalmology, 4th ed.
Baltimore: Williams & Wilkins, 1985.