Seesaw nystagmus with internuclear ophthalmoplegia from bilateral dorsomedial pons and left thalamus infarction: a case
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(2019) 13:352
CASE REPORT
Open Access
Seesaw nystagmus with internuclear ophthalmoplegia from bilateral dorsomedial pons and left thalamus infarction: a case report Qian Zhang and Jian Li*
Abstract Background: We 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 presentation: A 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. Conclusions: This 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. Keywords: Seesaw nystagmus, Internuclear ophthalmoplegia, Interstitial nucleus of Cajal, Bilateral dorsomedial pons infarction
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. While one eye elevates and intorts, the other eye depresses and extorts; the movement pattern is reversed in the remaining half of the cycle [1]. 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. INO is a complex ocular motility disorder caused by damage to the medial longitudinal fasciculus (MLF). SSN has been reported rarely in association with INO to the best of our knowledge. Here, we report the case of a patient with SSN and INO from bilateral dorsomedial pons and left thalamus infarction. These signs seem to be caused by selective damage to the excitatory fibers originating in the contralateral * Correspondence: [email protected] Department of Neurology, the First Affiliated Hospital of Jinzhou Medical University, No. 2, Section 5, People Street, Jinzhou 121000, Liaoning, China
vertical semicircular canal. The patient had various risk factors of cerebrovascular disease. Therefore, we propose that the acute onset of this constellation of signs is highly suggestive of pontine infarction.
Case presentation A 62-year-old man, right-handed, Chinese man, an entrepreneur, was admitted to our department for a day with sudden-onset dizziness, diplopia, and gait disturbance. He had a history of hypertension for 10 years and was currently taking the orally administered antihypertensive drug telmisartan. In addition, he had been diagnosed as having diabetes 4 years ago and was currently taking metformin. He suffered from cerebral infarction in 2009 and 2010 but had no residual neurological deficits. Beyond the above mentioned, he denied any history of tra
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