Bilateral internuclear ophthalmoplegia following head injury

A 40-year-old female after a closed head injury presented with bilateral internuclear ophthalmoplegia. Attempted convergence was abnormal and MRI revealed the focal hemorrhage in the medial longitudinal fasciculus region by showing bright signal in the a pontomesencephalic region in the midline on both T1 and T2 weighted images. The patient regained normal ocular mobility after six months of the injury. The medial longitudinal fasciculus, which is believed to be lesioned in cases of internuclear ophthalmoplegia, is an unusual and rare finding, particularly in patients victims of head injury without further neurological signs. Isolated internuclear ophthalmoplegia should be considered in the differential diagnosis when one encounters an adduction deficit in a patient suffering head injury.