Paralytic pontine exotropia in subarachnoid hemorrhage. A clinicopathological correlation

A syndrome of combined right lateral gaze palsy and right internuclear ophthalmoplegia, followed by a left exotropia in a case of subarachnoid hemorrhage is presented. At necropsy a single small pontine end-zone infarction was found, involving the medial part of the right paramedian pontine reticular formation, the tectospinal tract and the ventral part of the right medial longitudinal fasciculus. The fila radicularia of the right abducens nerve passed through the necrotic area. The mechanism of these characteristic ocular motor disturbances in relation to the post mortem findings and the topopathogenesis of the pontine infarction are discussed.