Foville's syndrome has rarely been reported in the otolaryngological journals, but in the ophthalmological journals several articles are available with short descriptions of the peculiarly manifested nystagmus. Foville's syndrome, as described in the textbook (J. G. CHUSID and J. J. MC DONALD, 1967), consists of contralateral hemiplegia with ipsilateral palsies of the sixth and seventh cranial nerves, internal strabismus with diplopia, and paralysis of some muscles of facial expression, as a form of the crossed hemiplegia from pontile lesion. In this paper, the authors present the case of Foville's syndrome and report the follow-up findings through the nystagmus and other clinical examinations, and gave their comments about the results from the standpoint of neurotology.
Case Report
Y. T., a 33 year old male patient, worker of an electric company, had been in good health, except for juvenile hypertension which was diagnosed at his age of 24, until September in 1966 when he began to have some tingling sensa- tion in the 3 rd and 4 th fingers on both sides during his ordinary job.
On December 28, 1966, he first felt the dizziness which was explained as “floating sensation or sea sick”, but accompanied with no disturbance of his consciousness or nausea when he stood upright. Shortly after the fit of dizzi- ness, a tingling and paretic sensation over his left back to his left leg and his left facial palsy developed to the difficulty in walking. At that time, he con- sulted with some doctor who checked his blood pressure telling him that he had high blood pressure (230 mmHg in the systolic pressure). Next morning, he was suffering from double vision and severe headache.
After this onset, the hemiplegic state of the left-side limbs became gradu-ally worse until the middle of January, '67, and then the symptoms sustained. In the middle of February, the paralytic degree of the hemiplegia became lesser, and he walked fairly well. Through that period, he noticed that the objects in front of him moved oscillatorily “up and down” and also some tin-nitus. Since the middle of June, the gait disturbance advanced again. He was admitted in the Brain Surgery ward in this University Hospital for the precise examination and treatment in July, '67. Physical examination revealed spastic palsies and lowered muscle power of the left limbs. There was no notable atrophy of the limb muscles but with some shaky movement of the left arm.
There were relatively accelerated reflexes of the biceps muscle and the triceps muscle found on the left side. Also, the Achilles and patellar tendon reflexes increased. Sensation reduced of pain, touch and temperature over the left side of the body as well as the left side of the face. Poor pointing performance of the finger-finger test and the finger-nose test; and also, the knee-heel test on the left side was poorly done. Adiadochokinesis was positive. But, no pathologic reflexes were noted. Blood pressure was 150/110 mmHg. Negative response in serologic syphilis test. Neurological findings: visual acuity was 0.5 in the left eye and 0.1 in the right. The right eyeball turned laterally to the nose, showing abducens paralysis.
Positive gazing palsy to the right side was seen. Facial paralysis on the right side was noticed as peripheral type, right exophthalmus, disappearance of the right nasolabial fold and some taste sense impairment on the right half of the tongue. C. A. G., P. E. G., audiogram and spinal fluid examination failed to detect any abnormal findings as far as the present stndies were concerned, but V. A. G. revealed the displacement of basilar artery to the left, because of the filling defect in the right anterior inferior cerebellar artery and arteriosclerotic figure.
Nystagmus:
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