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Case report
Bilateral paramedian pontine infarcts: a rare cause of bilateral horizontal gaze palsy
  1. Dmitriy Chernov1,
  2. Maria Elizabeth Karavassilis2,
  3. Farida Hassan3 and
  4. Mohit Bhandari3
  1. 1Acute Medicine, Watford General Hospital, Watford, UK
  2. 2Gastroenterology, Watford General Hospital, Watford, Hertfordshire, UK
  3. 3Stroke Medicine, Watford General Hospital, Watford, Hertfordshire, UK
  1. Correspondence to Dr Dmitriy Chernov; dmitriychernov0809{at}


A 73-year-old man presented to accident and emergency with headache and diplopia. Examination of the eye movements revealed a bilateral complete horizontal gaze palsy. On admission, a CT scan of the brain was performed, which was unremarkable. An MRI of the brain was then performed, which confirmed tiny acute infarcts involving the pons and the right cerebellum. This man was promptly treated with aspirin 300 mg one time per day, as per the stroke pathway. Further diagnostic workup later revealed atrial flutter. This man was therefore commenced on apixaban. The differential diagnoses for bilateral gaze palsy include the following: multiple sclerosis, infarction, haemorrhage and space occupying lesion. Bilateral gaze palsy is often associated with other neurological symptoms.

  • brain stem/cerebellum
  • cranial nerves
  • neuroimaging
  • stroke

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  • Contributors DC: collected information on patient’s case, designed layout, collaborated with stroke consultant in charge of patient care; contributed to Pathophysiology section and the Case summary; edited final draft of report; he is a sole contributor to design and creation of Figure 2; and obtained consent from patient’s relatives. MEK: responsible for Case Report Presentation and Outcome and Follow-Up sections of the report. FH: responsible for Discussion section of the report. MB: clinical supervisor; consultant stroke physician; identified the case and diagnosed the patient; and refined and edited the case report.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Next of kin consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.