Isolated Horizontal Gaze Palsy: Observations and Explanations

Abstract

We present three cases that we suggest require a novel diagnosis and a reconsideration of current understandings of pontine anatomy. In this case series, we highlight a series of patients with monophasic, fully recovering inflammatory lesions in the pontine tegmentum not due to any of the currently recognized causes of this syndrome. We highlight other similar cases in the literature and suggest there may be a particular epitope for an as-yet-undiscovered antibody underlying the tropism for this area. We highlight the potential harm of misdiagnosis with relapsing inflammatory or other serious diagnoses with significant adverse impact on the patient. In addition, we propose that this would support a reinterpretation of the currently accepted anatomy of the pontine gaze inputs to the median longitudinal fasciculus and paramedian pontine reticular formation.

Horizontal Gaze Palsy and Ipsilateral Facial Nerve Palsy in Older Patient as Initial Manifestation of Very Late-Onset Multiple Sclerosis Successfully Treated with Oral Corticosteroids: A Case Report

“…Horizontal gaze palsy is caused by a variety of causes, including pontine ischemic, hemorrhagic, neoplastic, or demyelination lesions [ 4 , 9 ]. Brain MRI is advised because nearly all MS patients with established disease and more than 80% of patients with clinically isolated syndrome who acquire MS have abnormal brain MRI results.…”