Abstract
We report a 67-year-old man with right conjugate deviation. He had right digiti quinti sign, right hemi paresthesia and right conjugate deviation, and no abnormal findings were observed on the first brain MRI, including diffusion weighted images (DWI) at the emergency unit. After admission, the symptoms worsened to bilateral gaze palsy and finally into tetraparesis. The second MRI DWI (18 hours after the first MRI) showed the responsible lesion from the bilateral ventral to paramedian dorsal medulla and lower dorsal pons. The gaze palsy recovered through symptoms of bilateral gaze palsy on the third day and left medial longitudinal fasciculus syndrome on the fourteenth hospital day. In many cases of early brain-stem infarction, it is difficult to detect the lesion of infarction in the acute phase. In this case, we examined eye movement more carefully, so we could diagnose the lesion of infarction from hour to hour. Therefore, it is important to examine eye movement for evaluation of ischemic area in brain stem.
