Abstract
An 81-year-old female complained of double vision and oscillopsia. Right medial longitudinal fasciculus (MLF) syndrome associated with convergence, trochlear and abducent palsies, and counterclockwise rotatory nystagmus was diagnosed. Her MR image showed infarction in the right tegmental portion of the pons. Symptoms of MLF syndrome and associated palsies resolved two weeks later, and the electronystagmography then revealed reduction of the quick phase of caloric nystagmus on the right and of transient ocular deviation (TOD) in head torsion to the right. These findings suggested that the primary lesion might be in the paramedian pontine reticular formation (PPRF) and have affected the MLF and nuclei of cranial nerves III, IV and VI for two weeks from the onset. The rotatory nystagmus recognized for two months was believed to have been caused by an ischemic lesion in the medulla which could not be seen in the MR image.
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