title: Acute onset of upbeat nystagmus, exotropia, and internuclear ophthalmoplegia--a tell-tale of ponto-mesencephalic infarct.
abstract: Two patients were assessed for acute onset of diplopia. Clinical examination revealed upbeat nystagmus, exotropia, and internuclear ophthalmoplegia (INO). Both patients had vascular risk factors; acute ischemic stroke affecting ponto-mesencephalic junction was suspected. Magnetic resonance imaging confirmed strategic location of the acute infarct affecting the medial longitudinal fasciculus, adjacent occulomotor nuclei, and paramedian tract. We propose that constellation of acute onset of upbeat nystagmus, INO, and exotropia in patients with vascular risk factors might be unequivocal manifestation of the ponto-mesencephalic stroke.
authors.affiliation: Department of Neurology, Case Western Reserve University, Cleveland, OH 44110, USA. aasefshaikh@gmail.com
authors.forename: Aasef G
authors.initials: AG
authors.lastname: Shaikh
authors.forename: Fatema F
authors.initials: FF
authors.lastname: Ghasia
authors.forename: Golta
authors.initials: G
authors.lastname: Rasouli
authors.forename: Michael
authors.initials: M
authors.lastname: DeGeorgia
authors.forename: Sophia
authors.initials: S
authors.lastname: Sundararajan
mesh_terms: D020520:Brain Infarction / Q000150:complications*; D005099:Exotropia / Q000150:complications*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008636:Mesencephalon / Q000473:pathology*; D008875:Middle Aged; D009759:Nystagmus, Pathologic / Q000150:complications*; D015835:Ocular Motility Disorders / Q000150:complications*; D011149:Pons / Q000473:pathology*
keywords: Brainstem; Diplopia; Dizziness; Infarction; Neural integrator; Stroke