[A case of post-traumatic medial longitudinal fasciculus syndrome]

Medial longitudinal fasciculus (MLF) syndrome recognized 2 days after a head injury is described. The patient was a 48-year-old man who had fallen from a ladder about 3m high. On his admission, scalp contusion on the left occipital area was noticed. Neurological examination revealed no neurological abnormalities except slightly disturbed consciousness. Plain skull X-ray films demonstrated a lineal skull fracture of the left occipital bone. Computed tomographic (CT) scans showed a slight subarachnoid hemorrhage within the bilateral sylvian fissures, but no parenchymal contusion in the brain stem was observed. On the 2nd day, when the patient regained full consciousness, impairment of adduction of the right eye and a fine nystagmus of the left eye on left lateral gaze were recognized. Convergence was intact. Right side MLF syndrome was diagnosed. This syndrome gradually disappeared followed by the initial improvement of adduction of the right eye, and the patient had completely recovered about 20 days after the head injury. Three major mechanisms leading to MLF syndrome caused by head injury are reported in the literature. They are: (1) primary brain stem injury, (2) secondary brainstem injury by trans-tentorial herniation, and (3) circulatory disturbance of perforating branches of the vertebro-basilar artery due to shearing force. In our case, the slightly disturbed consciousness at the time of the head injury indicates that this syndrome was not brought on by primary or secondary brain stem injury.(ABSTRACT TRUNCATED AT 250 WORDS)