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The authors report a single case (80-year-old female) of bilateral horizontal conjugate gaze palsy due to a dorsal median pontine haemorrhage. The patient presented with skew deviation, bilateral horizontal conjugate gaze palsy, vertical gaze palsy, ipsilateral lower motor neuron facial paresis, ipsilateral limb ataxia, contralateral hemiparesis and hemi-sensory loss, due to a haemorrhage in the inferior medial pons. The development of horizontal gaze palsy has been attributed to lesions in the pontine tegmentum, and in this case, has occurred in conjunction with other features as part of Foville’s syndrome. Complete horizontal gaze palsy is a rare clinical manifestation as bilateral involvement is unusual. The authors report their case as providing insight into the intricacies of the brainstem neuroanatomy through a description of the involved neural pathways and nuclei accounting for complex neurological manifestations in a single patient.

Complete horizontal gaze paresis due to medial pontine haemorrhage.
Sim JPY, Sim JJL, Saleem S, Cordato D.
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Claire Howard

Salford Royal NHS Foundation Trust, Salford, UK.

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