Pontine infarction with ocular motor disturbance, visual hallucination and ataxia - A report of two cases

We report on two patients suffering from ocular molor disturbance accompanied by visual hallucination, and ataxia caused by pontine infarction. The first patient was a 78-year-old man. He had left internuclear ophthalmoplegia (INO), visual hallucination patterns of a carpet or water when closing his eyes, and ataxia with dominancy in the lower extremities. The diffusion-weighted MRI showed a high intensity lesion in the left median portion of the tegmentum in the middle pons. The second patient was a 79-year-old woman. She had wall-eyed bilateral internuclear ophthalmoplegia (WEBINO) syndrome, ataxia, and visual hallucinations of moving goldfish and snakes. The diffusion-weighted MRI showed a high intensity lesion from the right median portion of the tegmentum to the dorsal part in the upper pons. Their hallucinations were vivid and colored. These visual hallucinations are similar to peduncular hallucinations but are only rarely reported in pontine infarctions. In both foci of the infarctions, the paramedian pontine reticular formation, lemniscus medialis, and medial longitudinal fasciculus were included and these symptoms were suggested to be associated dysfunctions of these anatomical structures.