Bilateral gaze paralysis with positive computerized tomography findings. A clinicoanatomic correlation

Area of Science:

• Neuroscience
• Ophthalmology
• Dermatology

Background:

• Mycosis fungoides, a type of cutaneous T-cell lymphoma, can rarely manifest with neurological complications.
• Ocular motor deficits, such as gaze paralysis, are uncommon but significant neurological signs.

Observation:

• A patient with mycosis fungoides presented with subacute, nearly isolated bilateral gaze paralysis.
• Enhanced computerized tomography (CT) imaging was utilized for in vivo clinicoanatomical correlation.

Findings:

• Two minute lesions were identified in the pontine tegmentum.
• The larger lesion precisely affected bilateral medial longitudinal fasciculus and paramedian pontine reticular formation (PPRF).
• This specific lesion was anatomically sufficient to explain the observed gaze palsy.

Implications:

• This case highlights the pontine tegmentum's critical role in coordinating eye movements.
• It demonstrates how specific, small brainstem lesions can cause distinct ocular motor deficits.
• Provides valuable in vivo clinicoanatomical evidence for understanding gaze control pathways.