Isolated bilateral internuclear ophthalmoplegia caused by minor head trauma is rarely reported.1,2 We present a case of bilateral internuclear ophthalmoplegia, exotropia, and accommodation deficit from an isolated discrete pontine hemorrhage following closed head trauma.
A previously healthy 53-year-old man was struck by a slow-moving vehicle. He complained of diplopia and vertigo after waking up 8 hours later. There was no external evidence of trauma. Mild gait unsteadiness and bilateral internuclear ophthalmoplegia with exotropia were seen (Figure 1). The magnetic resonance image, obtained 8 days later, showed only a focal upper pontine hemorrhage (Figure 2). His eye movements and gait unsteadiness slowly improved over 3 months.
Bilateral internuclear ophthalmoplegia with exotropia in primary position.
T1-weighted (A) and gradient-echo (B) magnetic resonance images showing a discrete subacute hemorrhage extending ventrally from the floor to fourth ventricle at the upper pontine level.
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