Foville’s syndrome with bilateral INO and 6th cranial nerve palsy due to central pontine hemorrhage

초록

Introduction: Foville\'s syndrome is characterized with ipsilateral 6th nerve palsy, facial palsy, facial hypoesthesia, peripheral deafness, contralateral hemiparesis, ataxia, pain and thermal hypoesthesia. The syndrome suggested a lesion in lower pontine tegmentum. We recently experienced a rare interesting case of Foville’s syndrome with bilateral internuclear ophthalmoplegia (INO) and the 6th cranial nerve palsy followed by central pontine hemorrhage with extension to midbrain and medulla. Case report: A 31 year old woman with drowsy mentality was admitted to the emergency ward. She had symptoms of double vision, tingling sensation, and motor weakness of right side of her body just prior to the admission. Her both eyeballs were deviated medially. She was also suffered from left facial muscle weakness, decreased sensation on left face, left-sided hearing loss and also hoarseness. On cranial nerve exam, light reflex was preserved. Severe lateral gaze palsy and decreased eye adduction was observed in both eyes. When she gazed laterally, horizontal nystagmus was developed to medial side. And she had symptoms of right side hemiparesis and hypoesthesia. Her gait pattern was ataxic with a falling tendency to the left. Right side dysmetria was found in finger-to-nose test. On electromyographic examination, no motor unit was found on left facial muscles, including masseter. Brainstem auditory evoked potential study showed abnormal response on left side. Brain CT revealed acute central pontine hemorrhage larger in left side. MRI showed a pontine hemorrhage with a mass of heterogeneous signal, resembling soap-bubble appearance. The finding was possibly a cavernous m