Conjugate Eye Deviation and Horizontal Gaze Paresis due to Pontine Bleed

Right-sided conjugate eye deviation and left-sided horizontal gaze paresis
CT BRAIN showing a hemorrhage (bleed) in left dorso-medial pons region

65-year old man presented with acute onset right-sided numbness and deviation of eyes to the right side. He was unable to look to the left, suggestive of left-sided horizontal gaze paresis. CT Brain revealed a hemorrhage (bleed) in the left side of pons (dorso-medial region). The clinical findings can be explained by damage to the left sided abducens nucleus and PPRF (para-pontine reticular formation). In a pontine lesion, eyes look away from the side of lesion (in contrast, in a cortical lesion affecting frontal eye field, eyes look towards the side of lesion). Patient showed mild improvement and was discharged on the 4th day of admission.

Published by Dr Sudhir Kumar MD (Medicine) DM (Neurology)

I am a doctor with 25 years experience. I have worked as a neurologist for about 20 years. Educating public and healthcare professionals is very dear to me. This is possible due to my interactions with thousands of patients and their caregivers. I salute the patients who suffer and it is our duty to minimise suffering by preventing diseases and ensuring prompt diagnosis and treatment of those already affected.

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