Abstract
A 38-year-old male reported suffering from left hemiparesis starting 3 months ago. He felt weakness of his left lower extremity and numbness of the left elbow and hand. He was admitted to a local hospital and told he had a stroke. At the time, the patient also noticed blurry vision in his right eye. A CT scan of the brain revealed right pontine hemorrhage (Fig. 38.1). His corrected visual acuity was 6/12 in the right eye and 6/10 in the left eye. A Hirschberg test showed 10° of esotropia in the right eye and 10° of exotropia in the left eye. Krimsky test revealed 18 prism diopters of esotropia in the right and 20 prism diopters of exotropia in the left. Extraocular movements showed severe limitation of right gaze in both eyes (Fig. 38.2, Video 38.1). Anterior segments and fundoscopic examinations were normal in both eyes. Visual fields were full in both eyes. Brain MR imaging 3 months later showed tiny hemosiderin over the posterior pons with no other vascular lesions noted (Fig. 38.3). The patient was followed for 1 year. Visual acuity improved to 6/8.6 in the right and 6/6.7 in the left. He was orthophoric on primary gaze. However, limitation of the right gaze persisted.
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References
Wong AME. Eye movement disorders. Oxford: Oxford University Press; 2008. p. 130–1.
Bender MB. Brain control of conjugate horizontal and vertical eye movements: a survey of the structural and functional correlates. Brain. 1980;103(1):2369.
Bae YJ, Kim JH, Choi BS, Jung C, Kim E. Brainstem pathways for horizontal eye movement: pathologic correlation with MR imaging. Radiographics. 2013;33(1):47–59.
Carpenter MB, Batton RR III. Abducens internuclear neurons and their role in conjugate horizontal gaze. J Comp Neurol. 1980;189(1):191–209.
Tuzcu EA, Bayarogullari H, Atci N, Basarslan F, Coskun M, Yilmaz C, Ilhan N, Daglioglu M. Magnetic resonance imaging findings of the abducens nerves in type 1 Duane’s retraction syndrome. Semin Ophthalmol. 2014;29(3):142–5.
Verzijl HT, van der Zwaag B, Cruysberg JR, Padberg GW. Möbius syndrome redefined: a syndrome of rhombencephalic maldevelopment. Neurology. 2003;61(3):327–33.
Srinivas MR, Vaishali DM, Vedaraju KS, Nagaraj BR. Mobious syndrome: MR findings. Indian J Radiol Imaging. 2016;26(4):502–5.
Engle EC. Oculomotility disorders arising from disruptions in brainstem motor neuron development. Arch Neurol. 2007;64(5):633–7.
Bassetti C, Bogousslavsky J, Barth A, Regli F. Isolated infarcts of the pons. Neurology. 1996;46(1):165–75.
Pierrot-Deseilligny C, Goasguen J, Chain F, Lapresle J. Pontine metastasis with dissociated bilateral horizontal gaze paralysis. J Neurol Neurosurg Psychiatry. 1984;47(2):159–64.
Lee E, Kim JS, Kim JS, Song HS, Kim SM, Kwon SU. A small dorsal pontine infarction presenting with total gaze palsy including vertical saccades and pursuit. J Clin Neurol. 2007;3(4):208–11.
Sasaki K, Shimizu Y, Ujiie H, Kubo O, Hori T. A case of thrombosed arteriovenous malformation in the brain stem. No Shinkei Geka. 2001;29(7):653–7.
Caplan LR, Goodwin JA. Lateral tegmental brainstem hemorrhages. Neurology. 1982;32(3):252–60.
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Wang, AG. (2018). Pontine Hemorrhage with Horizontal Gaze Palsy. In: Emergency Neuro-ophthalmology . Springer, Singapore. https://doi.org/10.1007/978-981-10-7668-8_38
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