Rinsho Shinkeigaku (Clinical Neurology)

Case Report

Selective impairment and a unique recovery of bilateral horizontal gaze and facial palsy in a discrete pontine lesion: a case report

Kazuhiro Nagamine, M.D.1)2), Shogo Yazawa, M.D.1)3), Koichi Nakao, M.D.1)4) and Takekazu Ohi, M.D.5)

1)Department of Neurology, Miyazaki Prefectural Hospital of Nobeoka
2)Division of Neurology, Respirology, Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki
3)Department of System Neuroscience, Sapporo Medical University
4)Department of Neurology, Jichi Medical University
5)Department of Neurology, Kurashiki Central Hospital

A 77-year-old woman with bilateral horizontal gaze palsy, right hemifacial weakness and incomplete quadriplegia was transferred to our hospital. Brain magnetic resonance imaging on the first day revealed a slit-like signal deficit of the basilar artery and an abnormal signal area at the dorsal midline portion of the lower pons. Quadriplegia fluctuated in several days after admission, then disappeared finally. In spite of the recovery of quadriplegia, bilateral facial weakness appeared on Day 14 after the onset. Concerning the impairment of extraocular movements, bilateral adduction restored gradually followed by improvement of the right abduction. The clinical course suggested the involvement of bilateral medial longitudinal fasciculus (MLF) and abducens nuclei (or fibers) as the etiology of gaze palsy. Although bilateral MLF sign recovered within 3 weeks, and the abductor palsy of both eyes was persisted in mild degree. As imaging analysis did not always show the causative lesion, which correlated with the rapidly alternating signs in the patient, and careful neurological observation was therefore useful in the management of patients with brainstem dysfunction.
Full Text of this Article in Japanese PDF (549K)

(CLINICA NEUROL, 51: 125|129, 2011)
key words: bilateral horizontal gaze palsy, pontine infarction, medial longitudinal fasciculus, abductor palsy, bilateral facial weakness

(Received: 13-Jul-10)