Abstract
We report a case of upper pontine infarction with ipsilateral adduction palsy, convergence paralysis and alternating exotropia. A 77-year-old man revealed vomiting, diplopia, gait disturbance, numbness of the right face and palm, impaired adduction of the left eye, convergence paralysis, and alternating exotropia. MRI of the brain demonstrated a high intensity area in the left paramedian tegmentum of the upper pons, which was recognized as a new lesion. On the 7th day, the exotropia of the right eye improved in frontal gaze, in upper gaze and lower gaze. On the 12th day, the alternating exotropia disappeared. On the 16th day, at the time of discharge, exotropia was still evident. The adduction palsy, convergence paralysis and alternating exotropia could have been due to hyperactivity of the PPRF because of severe MLF damage.
