Neurologic examination diplopia goes away when one eye is covered CN 3,4,6 examination - extraocular movement right lateral gaze - left eye stay in the middle, right eye can do abduction but not adduction and nystagmus on abduction left lateral gaze - no movement, both eyes stay in the middle convergence - normal, other CN - normal, motor 5/5 all limbs, reflexes +2, plantars - flexor, sensory, cerebellar, gait - all normal
Where is the lesion? Localization
Lesion in Dorsal Pons affecting ipsilateral PPRF and ipsilateral MLF ipsilateral PPRF controls CN6 nuclei + contralateral CN3 via MLF ipsilateral MLF - ipsilateral CN3 (INO) PPRF - parapontine reticular formation MLF - medial longitudinal faciculus INO - internuclear ophthalmoplegia MRI shows small infarct in left dorsal pons
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