Foville syndrome with internuclear ophthalmoplegia in a filipino male with pontine ischemic stroke: A case report

INTRODUCTION

Stroke is defined as a syndrome of acute, focal neurological deficit attributed to a vascular injury to a part of the brain which can either be due to infarction or hemorrhage. Brainstem stroke is considered the most lethal form of all strokes accounting for a significant cause of morbidity and mortality. Foville syndrome is a rare neurological brainstem syndrome that was first described in France in 1858 by Achille-Louis Francois Foville. The classic presentation of this syndrome is a triad of ipsilateral horizontal gaze palsy, ipsilateral facial paralysis and contralateral hemiparesis or hemiplegia.

CASE

This is a case of a 55-year-old male who presented at the emergency room with left sided weakness associated with dizziness, blurring of vision at the left eye and vomiting. The patient is a known hypertensive, diabetic, had a previous history of stroke and is a diagnosed case of three vessel disease. Pertinent physical examination revealed an ipsilateral facial paralysis, left sided eye deviation and contralateral hemiparesis. MRI showed several small areas of restrictive diffusion throughout the pons and bilateral cerebellar hemispheres. The patient was admitted and started on antiplatelet and anticoagulation therapy. Physiotherapy was also done and the patient was eventually discharged after 13 days.

CONCLUSION

Foville syndrome is a brainstem stroke syndrome with only few reported cases worldwide. Moreover, additional deficits may accompany the syndrome if the neurologic injury is extensive. An internuclear ophthalmoplegia due to MLF damage often accompanies CN VI palsy resulting in conjugate gaze palsy. A detailed history and neurological physical examination, in combination with neuroimaging is essential to its diagnosis.

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