PMC5411421_01
Timeline of important events in the case with references to other Figures.
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F1
Neurontin (gabapentin; 300 mg per day) and Klonopin (clonazepam; 0.5 mg per day):see Figure 1. Neither medication abolished the nystagmus.
(A) Pontine hemorrhage imaged with gradient echo T2-weighted magnetic resonance imaging (MRI) within 24 h of hemorrhage. Left panels show consecutive 5-mm axial slices through the brainstem. Dashed squares highlight the region of hemorrhage. Right panels show 3.5x magnification of the highlighted region, with arrows indicating the hemorrhage (dark). The hemorrhage involved the pons and midbrain but not the medulla, primarily on the right side. (B) Axial images with turbo-spin echo T2-weighted MRI of medulla at time of hemorrhage (month 0:top panels), and after 4.5 months (month 4.5:bottom panels). Top panels: low (left) and higher (right) magnification images through the medulla (highlighted with dashed box) showed no evidence of hyperintensity at the time of hemorrhage. Bottom panels: bilateral focal hyperintensity of the anterior medulla at the level of the inferior olivary nucleus (arrows) was present at month 4.5, indicating the presence of hypertrophy. Scale bars = 1 cm.
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F2
A magnetic resonance imaging (MRI) performed within 24-h revealed hemorrhage in the right pons and midbrain, with extension across the midline (Figure 2A). This prompted a second MRI at 4.5 months, which revealed no new hemorrhage or infarct, but instead showed hypertrophic degeneration of the inferior olivary nucleus (Figure 2B). If the oculomotor nucleus is also damaged (as with our subject:Figure 2A, top right), this may also contribute to the impairment of eye movements.