Acute Lacunar Infarct in the Right Dorsal Pons Presenting as Internuclear Ophthalmoplegia Following Percutaneous...

A 58-year-old male with a history of type 1 diabetes, hypertension, smoking, and obesity, was seen by the inpatient neurology team for symptoms of dizziness and diplopia after cardiac catheterization. His symptoms caused him to feel nauseated and vomit and were improved with closing his right eye. It was noted that he was unable to adduct his right eye and had nystagmus of his left eye on exam. He had no ptosis, and convergence was preserved. The remaining physical exam was normal. Initial limited magnetic resonance imaging (MRI) was within normal limits; however, repeat limited brain MRI without contrast with brainstem cuts revealed punctate focus on restricted diffusion in the right dorsal pons compatible with a small acute infarct. He was started on dual antiplatelet therapy for 21 days followed by aspirin monotherapy daily, and rosuvastatin 40 mg daily. The patient was scheduled to follow up in the stroke clinic in 3 months and was also referred to ophthalmology, who recommended monitoring symptoms, which were gradually improving with an eye patch, indicating that he would likely slowly improve on his own.