A Case of pontine hemorrhage revealed horizontal conjugate gaze palsy and disorder of speech discrimination

Abstract

Brainstem disorders are often characterized by abnormal eye movements, however, the type of abnormal movements vary depending on the localization and severity of the damage. Here, we report a case of pontine hemorrhage who exhibited horizontal conjugate gaze palsy and disorder of speech discrimination. The 34-year-old man presented with eye pain and dull feeling malaise?, disorder of speech articulation and torpor paralysis ?? of the left side of the body of sudden onset, that developed while he was driving a car. Clinical examination revealed horizontal conjugate gaze palsy, both rightward and leftward, while vertical gaze and convergence were normal. Although the pure-tone audiogram and DPOAE were within normal range, ABR showed prolongation of latency, and reduction of speech discrimination was recognized. MRI revealed evidence of hematoma and edema extending from the mid-dorsal aspect to the right side of the pons. Based on the findings, the patient was diagnosed to have pontine hemorrhage due to hypertension affecting the right facial nerve nucleus, right pyramidal tract, bilateral abducens nuclei, MLF, PPRF and the auditory neural pathway. Although the symptoms of pyramidal tract and auditory disorder resolved by day 19 when he was?? moved to another hospital, the other neurological symptoms were persistent.