311 - A Pontine Puzzle: Piecing Together the Presentation of Foville Syndrome

A 43-year-old male admitted to the intensive care unit (ICU) following unarousable state at home after hypertensive emergency. Upon ICU admission, patient’s neurologic deficits included right hemiparesis, withdrawal to pain in right upper extremity, localized pain in left upper extremity and no eye opening. CT head demonstrated a 2.2 × 2.1 cm left paramedian pontine hemorrhage with trace intraventricular hemorrhage (IVH); MRI demonstrated extension toward the left cerebral peduncle; MRA confirmed no aneurysm/stenosis present. Etiology favored a hypertensive cause. Upon admission to the rehab unit, patient exam was significant for left abduction palsy, dysarthria, left sided facial droop, and right hemiparesis. During his rehabilitation stay, he was found to have nystagmus, ataxia, intermittent dizziness, and left hearing deficit. A comprehensive, multidisciplinary rehabilitation program was required to optimize his functional recovery and symptomatic care.


Discussions: Foville Syndrome, or inferior medial pontine syndrome, is a rare neurologic disorder characterized by presentation of ipsilateral abduction deficit of the eye secondary to CN VI injury, ipsilateral facial weakness secondary to CNVII injury, and contralateral hemiparesis due to corticospinal tract damage. Hemorrhage extension led this patient to exhibit additional cranial nerve findings of ipsilateral sensorineural hearing loss secondary to vestibulocochlear nuclear palsy, further complicating activities of daily living and balance retraining.  Rehabilitation programs tailored to an individual's specific needs and functional goals improves long-term outcomes and promotes recovery.

Conclusions: Foville syndrome is characterized by gaze palsy, hemiparesis, and facial nerve involvement due to a brainstem lesion. Early recognition is important to facilitate communication with specialists and formulate long term management plans. Accurate diagnosis enhances outcomes and fosters functional recovery. Multidisciplinary care involving rehabilitation specialists, ophthalmologists, otolaryngologists, neurologists, and other healthcare professionals plays a vital role in supporting individuals and caregivers with Foville syndrome.