PT  - JOURNAL ARTICLE
AU  - Shaker, Hussam
AU  - Hamdallah, Abdallah
AU  - Senay, Blake
AU  - Rai, Vivek
TI  - Frontal eye field ischemic stroke presenting with internuclear opthalmoplegia: case report and review of anatomy (P3.251)
DP  - 2018 Apr 10
TA  - Neurology
PG  - P3.251
VI  - 90
IP  - 15 Supplement
4099  - http://n.neurology.org/content/90/15_Supplement/P3.251.short
4100  - http://n.neurology.org/content/90/15_Supplement/P3.251.full
SO  - Neurology2018 Apr 10; 90
AB  - Objective: To describe a case of internuclear ophthalmoplegia (INO) in the setting of Frontal eye field (FEF) ischemic stroke and review relevant anatomyBackground: INO is a recognized manifestation of MLF lesions, most typically caused by demyelinating disorders of brain. It is rarely a consequence of unilateral FEF lesion.Design/Methods: Case report and review of literatureResults: We report a case of 70-year-old male, with a history of atrial fibrillation and watchman procedure for left atrial appendage occlusion, who presented with horizontal diplopia. Neurologic examination revealed impaired adduction of the right eye associated with nystagmus of the left abducting eye (R. Internuclear ophthalmoplegia) with preserved convergence. MRI brain showed diffusion restriction in right inferolateral frontal lobe in the middle frontal gyrus, along with hyperintense T2 signal and low apparent diffusion coefficient, likely representing acute ischemic stroke in right frontal eye field. There was no abnormal signal in brainstem area.The frontal eye field is considered cortical area for controlling horizontal gaze movements. It communicates with extraocular muscles indirectly via the paramedian pontine reticular formation (PPRF). Destruction of the FEF causes deviation of the eyes to the ipsilateral side. There is a consensus that INO results from damage to interneurons within the medial longitudinal fasciculus (MLF) coursing from the cranial nerve (CN) VI nucleus in the dorsomedial pons to the contralateral medial rectus subnucleus of CN III in the upper midbrain. INO caused by stroke affecting the MLF is typically demonstrable on MRI as opposed to INO caused by demyelination. The proposed mechanism of our patient’s finding is presence of unique pathway that starts from FEF and bypasses PPRF to directly project to MLF.Conclusions: This report suggests that there is a unique bundle originating from FEF that projects directly to ipsilateral MLF. Clinico-radiological studies are needed to further define unique relationship between FEF and MLF.Disclosure: Dr. Shaker has nothing to disclose. Dr. Hamdallah has nothing to disclose. Dr. Senay has nothing to disclose. Dr. Rai has nothing to disclose.