North Texas Research Forum 2025
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Division
North Texas
Hospital
Medical City Arlington
Specialty
Emergency Medicine
Document Type
Poster
Publication Date
2025
Keywords
palsy, pontine infarction
Disciplines
Emergency Medicine | Medicine and Health Sciences | Nervous System Diseases
Abstract
Isolated unilateral medial rectus palsy is a rare but significant clinical manifestation of acute pontine infarction, often presenting without the typical neurological deficits seen in brainstem strokes. This case report highlights a 61-year-old male with a history of hypertension and diabetes who presented with four days of double vision, with no other significant neurological symptoms such as headache, speech disturbances, or focal weakness. On examination, the patient exhibited an isolated inability to adduct his left eye, without any visual deficits or abnormalities in other cranial nerve functions. Neuroimaging, specifically MRI, confirmed the diagnosis of an acute left pontine infarction. The medial rectus muscle, which facilitates eye adduction, is innervated by the oculomotor nerve and its function is coordinated by the medial longitudinal fasciculus (MLF). Lesions affecting the MLF, often due to pontine strokes, can result in isolated medial rectus palsy, a condition that may be challenging to diagnose, especially when no other oculomotor deficits are present. This case underscores the importance of considering acute stroke in the differential diagnosis when encountering isolated ocular motor abnormalities, particularly in patients with risk factors such as hypertension and diabetes. Early neuroimaging is essential for confirming the diagnosis of pontine infarction, distinguishing it from other potential causes of eye movement abnormalities, such as demyelinating diseases or mechanical injuries. The timely recognition of such conditions is critical, as it allows for appropriate intervention and management to reduce the risk of long-term deficits. Furthermore, this case emphasizes the need for a multidisciplinary approach involving neurologists, ophthalmologists, and rehabilitation specialists to optimize patient care. With early diagnosis and management, some patients may experience partial or complete recovery of eye movement, while others may require ongoing rehabilitation to address residual deficits.
Original Publisher
HCA Healthcare Graduate Medical Education
Recommended Citation
Bingham, Miranda; Frand, Shterna; Meadows, Charley; and Sharma, Sanjay, "Isolated Unilateral Medial Rectus Palsy Due to Acute Pontine Infarction" (2025). North Texas Research Forum 2025. 55.
https://scholarlycommons.hcahealthcare.com/northtexas2025/55