Pontine Hemorrhage with Horizontal Gaze Palsy
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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