Extended Foville Syndrome Due to a Pontine Tegmental Hemorrhage: A Clinicoradiologic Case Report

Foville syndrome is a rare pontine tegmental syndrome classically characterized by ipsilateral abducens and peripheral facial nerve palsies with contralateral hemiparesis. Extended variants involving additional ocular motor, sensory, and autonomic pathways are uncommon, particularly when caused by hemorrhagic stroke. We report a 59-year-old Filipino male with uncontrolled hypertension who presented within hours of symptom onset with left lateral rectus paresis, left peripheral facial palsy, moderate dysarthria, right hemiparesis, and mild right hemisensory loss, with a National Institutes of Health Stroke Scale (NIHSS) score of 7. Non-contrast computed tomography demonstrated a focal left pontine tegmental hemorrhage. On the first hospital day, the left abducens deficit progressed to complete palsy, the right-sided sensory deficit worsened, and left internuclear ophthalmoplegia and Horner's syndrome emerged, with an increase in NIHSS to 9. The patient was managed conservatively and underwent rehabilitation. At 1.5 months postictus, he was ambulatory with assistance with a modified Rankin Scale (mRS) score of 3. At 8 months, his NIHSS had improved to 6 and his mRS to 2, with independent ambulation despite residual focal neurological deficits. This case demonstrates the value of serial neurological examination and clinicoradiologic correlation in localizing evolving pontine tegmental lesions and illustrates meaningful functional recovery despite persistent deficits following focal pontine hemorrhage.