Pontine Infarction Demonstrated by MRI

A 52 year old left-handed man suffered a right hemisphere stroke one week after a myocardial infarction. He rapidly recovered speech and motor function and was anticoagulated with Coumadin. Six weeks later he had a brainstem infarction. Physical signs included quadriparesis, worse on the right, severe dysarthria, inability to swallow and hyperactive gag. Mentation was clear and he was able to communicate on an alphabet board. Pupils reacted normally to light and accommodation. At rest, in primary position, his eyes were aligned, but any attempted lateral gaze, either by pursuit or saccade produced pronounced convergence movements accompanied by miosis. Up and down gaze were well preserved.