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Acute onset internuclear ophthalmoplegia responsive to treatment with intravenous alteplase.

Isolated pontine infarcts account for approximately 3% of ischaemic strokes in hospital registry studies.1 Symptoms may include sensory or motor power loss, involuntary movements (eg, palatal myoclonus, periodic limb movements), impairment of consciousness and emotional disturbances (eg, pathological laughing or crying). Internuclear ophthalmoplegia (INO) occurs due to dysfunction of the medial longitudinal fasciculus within the pons due to occlusion of paramedial branches of the basilar artery and is the main presenting feature in 0.5% of all ischaemic stroke patients.2 An INO is characterised by paralysis of adduction of the ipsilateral eye for all conjugate gaze movements and nystagmus of the contralateral eye when this eye is in abduction. Here we present the case of a young man presenting with acute INO which responded rapidly to treatment with intravenous alteplase.