Background: Horizontal conjugate eye deviation (HCED) is typically associated with supratentorial strokes affecting the frontal eye fields and associated pathways. However, a rare form of HCED, ocular ipsipulsion, is caused by a lateral medullary lesion. The presumed mechanism involves disruption of decussating olivocerebellar fibers, leading to an imbalance in vestibular nuclei activity.
Purpose: To report a case of isolated ocular ipsipulsion as a diagnostic clue to central vertigo.
Research Design: Case report.
Study Sample: An 82-year-old man with a right lateral medullary infarction.
Data Collection: Neurological examination and brain magnetic resonance imaging (MRI) were performed. Ocular findings were documented through bedside observation and video recording.
Results: The patient presented with acute vertigo and HCED consistent with ocular ipsipulsion, without other neurological signs. On brain MRI a right lateral medullary infarction was observed.
Conclusions: This oculomotor dysfunction can be the only clue in the neurological examination to suspect a central vertigo. Clinicians should be aware of this sign and include its assessment in the bedside evaluation of acute vertigo in the emergency setting if a central cause is suspected.
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