Abstract
BackgroundWe describe for the first time the clinical features and mechanisms of a bilateral dorsomedial pons and left thalamus infarction with seesaw nystagmus and internuclear ophthalmoplegia.Case presentationA 62-year-old Chinese man was hospitalized for sudden-onset dizziness, diplopia, and gait disturbance. A neurological examination revealed seesaw nystagmus and internuclear ophthalmoplegia. Magnetic resonance imaging disclosed an acute infarction confined to the bilateral dorsomedial pons and left thalamus. Subsequently, 2 weeks of antithrombotic therapy led to an improvement in his symptoms.ConclusionsThis case illustrates that the acute onset of seesaw nystagmus and internuclear ophthalmoplegia accompanied by risk factors for cerebrovascular diseases are highly suggestive of brainstem infarction.
Highlights
Seesaw nystagmus (SSN) is a rare ocular motor disorder characterized by cyclic eye movements with a conjugate torsional component and a dissociated vertical component
The Internuclear ophthalmoplegia (INO) is characterized by adduction paresis of the ipsilesional eye and dissociated abducting nystagmus of the contralesional eye on attempted gaze to the contralesional side, a complex ocular motility disorder caused by damage to the medial longitudinal fasciculus (MLF)
Our patient, who had many cerebrovascular risk factors, had SSN and INO as sole manifestations of infarction in the bilateral dorsomedial pons; an acute ischemic stroke affecting the pontine junction was strongly suspected at the beginning
Summary
Introduction Seesaw nystagmus (SSN) is a rare ocular motor disorder characterized by cyclic eye movements with a conjugate torsional component and a dissociated vertical component. Internuclear ophthalmoplegia (INO) is characterized by adduction paresis of the ipsilesional eye and dissociated abducting nystagmus of the contralesional eye on attempted gaze to the contralesional side. SSN has been reported rarely in association with INO to the best of our knowledge.
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