A Case of Brainstem Infarction with Paralytic Pontine Exotropia

Abstract

We encountered a case of brainstem infarction with paralytic pontine exotropia. A 74-year-old male with hypertension, hyperlipidemia and diabetes complained of dizziness on day 1. He developed vertigo on day 5 and came to our hospital on day 7. CT findings were normal, but he showed spontaneous nystagmus to the right and one-and-a-half syndrome in addition to ataxia. On the same day, he was admitted to our hospital and MRI was performed. MRI (T2WI and diffusion) showed a high intensity area on the middle-left side of the lower pons. We considered that he had initially had TIA and developed brainstem infarction on day 7. We suggested that impairment of eye movement was caused by paralytic pontine exotropia, which followed one-and-a-half syndrome. After treatment, ataxia recovered, but impairment of eye movement remained. Neurological examinations are important even in cases showing normal CT findings.