A Case Report of Wall-Eyed Bilateral Internuclear Ophthalmoplegia with Bilateral Facial Palsy.

Case reports of bilateral facial palsy with horizontal gaze restriction are rare. A 62-year-old woman experienced sudden onset of bilateral adduction deficits, bilateral abducting nystagmus accompanied with facial diplegia. We confirmed acute ischemic stroke in the midline dorsal pons, where medial longitudinal fasciculus (MLF) and facial nerve fascicles are located. This can be explained by vascular variation of pontine perforating arteries.

[A case of bilateral medial medullary and left tegmentum of pontine infarction in whom DSA-MR fusion imaging identified infarct-relevant arteries].

We herein reported a patient with acute ischemic stroke in the bilateral medial medullary and the left tegmentum of the pons who presented with various neurological symptoms. Fusing digital subtraction angiography (DSA) and MRI (DSA-MR fusion imaging) could reveal the infarct-relevant arteries. A 41-year-old male presented with headache, bilateral arm's dysesthesia, quadriplegia, left Horner's syndrome, upbeat nystagmus, internuclear ophthalmoplegia and left peripheral facial paralysis. Diffusion weighted MRI (DWI) revealed the high intensity lesion in the bilateral medial medullary and the left tegmentum of the pons. MRA showed right vertebral artery (VA) occlusion. A high intensity on T1 weighted imaging was shown on the right VA vessel wall. DSA-MR fusion imaging revealed the anterior spinal artery (ASA) occlusion proximal to the infarction. The stenosis was located at the origin of the right VA perforating branch distributing into the infarct lesion. The steno-occlusive lesion of ASA and VA perforating branch due to VA dissection resulted in infarction in the pontomedullary junction and caused various neurological symptoms. DSA-MR fusion imaging would prove the radiological anatomy of infarct-relevant arteries and clarify the etiology of ischemic stroke.

The Medial Pontine Mid-Tegmentum Syndrome.

Isolated pontine infarcts are common and are often associated with well-described syndromes that are classified based on their specific clinical presentation and arterial stroke territories. Here we present a case of acute combined diplopia and unilateral lower extremity sensory abnormality. Diffusion-weighted magnetic resonance imaging revealed a punctate area of acute ischemia in the right medial pontine mid-tegmentum. These findings suggest a unique pontine stroke syndrome characterized by acute ischemic injury at the intersection of the medial lemniscus and cranial nerve VI.

Patterns of pontine strokes mimicking Bell's palsy.

BACKGROUND: Peripheral-type facial palsy very rarely arises from pontine stroke. We attempted to identify unique clinico-radiologic patterns associated with this condition. CASE PRESENTATION: Patients with pontine tegmentum stroke and acute onset of peripheral-type facial weakness were reviewed from the acute stroke registry of a tertiary hospital. The clinico-radiologic patterns of 10 patients were classified into one of three types based on the respective stroke mechanism. Type A (n = 5) was characterized by relatively diverse clinical presentations and larger, multiple infarctions resulting from large-artery atherosclerosis. Three cases with small lacunar infarcts were classified to type B (small vessel occlusion), and they showed only limited symptoms including horizontal gaze disturbance and facial paralysis. The two hemorrhagic cases (type C) presented with a focal pontine hemorrhage, likely due to a cavernous hemangioma. CONCLUSIONS: Peripheral-type facial palsy often occurs in pontine stroke with specific patterns. Type recognition helps to determine the underlying mechanism and the appropriate clinical approach. In particular, focal pontine tegmental infarctions showing stereotypic combinations of ophthalmoplegia and peripheral-type facial weakness (type B) might be recognized as a new type of lacunar syndrome.

[Nuclear paralysis of the oculomotor nerve within the context of traumatic brain injury]. / Paralisis nuclear del III par craneal en el contexto de un traumatismo craneoencefalico.

TITLE: Paralisis nuclear del III par craneal en el contexto de un traumatismo craneoencefalico.

Eight Syndrome: Horizontal Gaze Palsy Plus Ipsilateral Seventh Nerve Palsy.

A 62-year-old woman developed a right horizontal gaze palsy and ipsilateral facial nerve palsy due to a right pontine tegmentum infarct. This constitutes a forme fruste of the eight-and-a-half syndrome that we have termed the eight syndrome.

Severe ataxia due to injuries of neural tract detected by diffusion tensor tractography in a patient with pontine hemorrhage: A case report.

RATIONALE: We examined injuries of the dentato-rubro-thalamic tract (DRTT), cortico-ponto-cerebellar tract (CPCT), dorsal spinocerebellar tract (SCT), and inferior cerebellar peduncle (ICP) in a patient with severe ataxia following bilateral tegmental pontine hemorrhage (PH), using diffusion tensor tractography (DTT). PATIENT CONCERNS: A 75-year-old female patient underwent conservative management for bilateral tegmental PH. She presented with moderate motor weakness, severe resting and intentional tremor on both hands, and severe truncal ataxia (Scale for Assessment and Rating of Ataxia [25 points/0-40 points: a higher score indicates a worse state]), and she was not able to sit independently. DIAGNOSES AND OUTCOMES: On DTT taken at 2 weeks after initial presentation, both DRTTs and the left dorsal SCT were not reconstructed, whereas the CPCTs showed thinning of the entire pathways between the primary sensorimotor cortex and cerebellum in both hemispheres. The right ICP was discontinued at the transverse cerebellar branch of the ICP and thinning of the left ICP was observed in the vertical and transverse cerebellar branch of the ICP. LESSONS: Using DTT, concurrent injuries of the DRTT, CPCT, dorsal SCT, and ICP were demonstrated in a patient with severe ataxia following PH. Our result suggests the necessity of evaluation of these neural tracts in patients who develop ataxia after brain injury.