Internuclear Opthalmoplegia as a Symptom of Ischemic Stroke in a Girl With Patent Foramen Ovale

      A previously healthy 16-year-old girl presented with sudden-onset diplopia and dizziness. Both symptoms appeared on the day of admission, soon after awakening in the morning. The day before admission, she complained of a headache followed by transient numbness in the right half of her face. Neurological examination revealed an internuclear ophthalmoplegia (limited adduction in the left eye with a horizontal nystagmus in the right eye during attempted right gaze, Figure A-D).
      Figure thumbnail gr1
      Figure(A) Forward gaze. (B) Upward gaze. (C) Limited adduction in the left eye with a horizontal nystagmus in the right eye while attempting a right gaze. (D) Left lateral gaze. (E,F) Magnetic resonance imaging T2-weighted images showing a hyperintense focus on the left side of the midbrain at the level of quadrigeminal lamina. (G) Magnetic resonance imaging diffusion-weighted image showing a high signal on the left side of the midbrain. (H) Apparent diffusion coefficient map with a low signal on the left side of the midbrain. (The color version of this figure is available in the online edition.)
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