Internuclear ophthalmoplegia by a lesion in the isthmus of the hindbrain

Susumu Nagasaka Departments of Neurosurgery and Radiology, School of Medicine, Fukuoka University, Fukuoka, Japan

Takeo Fukushima Departments of Neurosurgery and Radiology, School of Medicine, Fukuoka University, Fukuoka, Japan

Hidetsuna Utsunomiya Departments of Neurosurgery and Radiology, School of Medicine, Fukuoka University, Fukuoka, Japan

Syouichi Arai Departments of Neurosurgery and Radiology, School of Medicine, Fukuoka University, Fukuoka, Japan

Masamichi Tomonaga Departments of Neurosurgery and Radiology, School of Medicine, Fukuoka University, Fukuoka, Japan

Abstract

We report a patient with prominent unilateral internuclear ophthalmoplegia (INO) and intermittent skew deviation. Magnetic resonance imaging (MRI) clearly revealed an infarcted lesion in the isthmus of the hindbrain which involved almost exclusively the region of the right medial longitudinal fasciculus (MLF). The skew deviation of the patient was not ascribed to the trochlear nerve on the basis of neurological findings, although the nucleus and fascicles of the trochlear nerve were ajacent to the infarction on the imaging study.

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Internuclear ophthalmoplegia by a lesion in the isthmus of the hindbrain

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Internuclear ophthalmoplegia by a lesion in the isthmus of the hindbrain

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