Abstract
We report a case involving a patient who underwent rehabilitation following onset of pons tegmentum hemorrhage. The initial diagnosis was a disorder of paramedian pontine reticular formation (PPRF), but this was changed over the course of observation to bilateral medial longitudinal fasciculus (MLF) syndrome and dissociation associated with vertical nystagmus. Reports of rehabilitation in a patient with a severe disturbance of ocular motility are rare. Improvement was seen in bilateral abduction and adduction of the right eye, but no improvement was seen in adduction of the left eye or in vertical nystagmus during forward and vertical gaze. Lateral gaze disturbances, possibly present due to hematoma-associated pressure, may have improved spontaneously over time, with rehabilitation using convergence movement helping to shorten the time to improvement, suggesting that such treatment is effective in improving lateral gaze disturbances. However, the vertical gaze nystagmus in this patient was thought to be irreversible, given that the ascending medial longitudinal fasciculus had been severed as a result of the pontine hemorrhage, which prevented the development of a mechanism to compensate for it.
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