Foville's syndrome with ipsilateral internuclear ophthalmoplegia due to spontaneous pontine hemorrhage

Abstract

A 30-year-old male presented to the emergency department with a complaint of acute headache with pain in the right eye and simultaneous weakness and numbness on his left side. Results of ophthalmic examinations showed limited abduction and adduction only in the right eye, while the vertical movement was normal. Mild ptosis with concurrent miosis oculus dexter was also found. A neurological examination revealed left hemiplegia, left hemiparesthesia, left-side sensory ataxia, right facial palsy, and right facial analgesia. Computer tomography revealed a 2.4-cm high-density hemorrhage in the bilateral dorsal aspect of pons, more at the right side. Foville's syndrome with ipsilateral internuclear ophthalmoplegia was diagnosed and the patient received supportive treatment. The patient later complained of left hearing loss and the brainstem auditory evoked potential study suggested a peripheral lesion. Follow-up magnetic resonance imaging studies at the 3rd and 10th months showed old pontine hemorrhage with right hypertrophic olivary degeneration (HOD). We reported a rare case of Foville's syndrome with ipsilateral internuclear ophthalmoplegia due to spontaneous pontine hemorrhage. The clinical manifestations correlated well with anatomical involvement. The sequela of HOD after potine hemorrhage should be monitored for the possible late-onset movement disorder.