Non-Paralytic Pontine Exotropia Rapidly Switching to Esotropia in a Pontine Stroke - A Case Report

Non-paralytic pontine exotropia (NPPE) is a rare condition characterized by internuclear ophthalmoplegia associated with exotropia in the contralateral eye. We report a case of an 82-year-old woman with acute onset of right eye exotropia and adduction deficit of the left eye. Magnetic resonance imaging showed areas of restricted diffusion in the left paramedian midbrain, left precentral gyri, and right superior parietal gyri. She recovered after 3 days. On the seventh day after onset, the left eye appears with an esotropia, a finding never described before in NPPE. For a better understanding of the pathophysiology and recognition of NPPE, more reports like this are essential to encourage more publications on the topic and the creation of guidelines for this type of ophthalmoplegia.