Bilateral paramedian pontine infarcts: a rare cause of bilateral horizontal gaze palsy

Abstract

A 73-year-old man presented to accident and emergency with headache and diplopia. Examination of the eye movements revealed a bilateral complete horizontal gaze palsy. On admission, a CT scan of the brain was performed, which was unremarkable. An MRI of the brain was then performed, which confirmed tiny acute infarcts involving the pons and the right cerebellum. This man was promptly treated with aspirin 300 mg one time per day, as per the stroke pathway. Further diagnostic workup later revealed atrial flutter. This man was therefore commenced on apixaban. The differential diagnoses for bilateral gaze palsy include the following: multiple sclerosis, infarction, haemorrhage and space occupying lesion. Bilateral gaze palsy is often associated with other neurological symptoms.

A case of pure bilateral horizontal gaze palsy due to multiple sclerosis

“…Bilateral horizontal gaze palsy was also reported in the patients with vitamin B1 deficiency 9 and stroke, 10 but was often accompanied by other cranial nerve symptoms. INO is a characteristic feature of MS 1 .…”

“…We reviewed seven previously documented patients with complete bilateral horizontal gaze palsy and MS (Table 1). Bilateral horizontal gaze palsy was also reported in the patients with vitamin B1 deficiency 9 and stroke, 10 but was often accompanied by other cranial nerve symptoms. INO is a characteristic feature of MS. 1 The pure horizontal gaze palsy may be also a characteristic feature of MS.…”

Foville Syndrome Due to Pontine Hemorrhage and Pontine Infarct: Case Series

“…Basic investigations like complete blood count, serum glucose, serum electrolytes, renal and liver function tests, lipid profile, and a 12-lead electrocardiogram are routinely ordered. Various other biomarkers (e.g., c-Fn, MMP-9) are being investigated as possible predictors of stroke outcomes and can very well be recommended as routine tests for all stroke patients in the future (Chernov, D. 2019;Kamo, H. 2019;Zhang, H-T. 2018;Yilmaz, TF. 2017).…”