This is the first reported anatomic study of a case of posterior internuclear ophthalmoplegia. The patient developed a transient conjugate gaze palsy and facial palsy with crossed hemiplegia. The alternating facial hemiplegia persisted, but the conjugate gaze palsy rapidly resolved into a lateral rectus palsy with absence of vestibulo-abducens reflex. The lateral rectus palsy in this case is attributed to a supranuclear (or internuclear?) lesion involving the left abberant pyramidal tract in the pons. The historic and clinic or anatomic relationships between the posterior internuclear ophthalmoplegia of Lutz (1923), the ipsilateral conjugate gaze and facial palsies with contralateral hemiplegia of Foville (1859), and the ipsilateral facial palsy with contralateral hemiplegia of Millard (1855) and Gubler (1856), all of which this patient showed, are reviewed, and hopefully clarified.
Rothstein TL, Alvord EC. Posterior Internuclear OphthalmoplegiaA Clinicopathological Study. Arch Neurol. 1971;24(3):191–202. doi:10.1001/archneur.1971.00480330019001