A 43-year-old woman with no medical history suddenly had complete loss of horizontal eye movements. A nuclear magnetic resonance (NMR) scan showed multiple paraventricular lesions, suggesting multiple sclerosis (MS), and a solitary brain-stem lesion in the ventral periaqueductal region. Simultaneous bilateral involvement of horizontal gaze is rare but may be seen in several conditions, including MS.
REPORT OF A CASE
A 43-year-old woman experienced headache, vomiting, and photophobia three weeks prior to admission. She also noticed unsteadiness and intermittent double vision. These symptoms progressed so that four days prior to admission she was unable to move her eyes in any direction.On examination at admission she had regained full vertical conjugate eye movements, but there was only minimal voluntary horizontal gaze to the right and none to the left (Fig 1). Convergence was normal. On oculocephalic stimulation, conjugate horizontal movements were of reduced amplitude bilaterally but were full on cold
Joseph R, Pullicino P, Goldberg CDS, Rose FC. Bilateral Pontine Gaze Palsy: Nuclear Magnetic Resonance Findings in Presumed Multiple Sclerosis. Arch Neurol. 1985;42(1):93–94. doi:10.1001/archneur.1985.04060010103027
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