Category: Clinical Sciences/Health Conditions
8-year-old male, with initial presentation of double vision and difficulty going upstairs, found to have MRI findings of 3.0 x 2.8 x 2.6 cm3 enhancing heterogeneous mass in the right pons extending to the right middle cerebellar peduncle and superior aspect of right cerebellar peduncle, biopsy showed GFAP positive high-grade glioma. He was admitted to inpatient rehabilitation, 2 weeks after resection. We observed good functional recovery of iatrogenic Foville’s Syndrome after 4 weeks of inpatient rehabilitation.
The child developed transient mutism after surgery, lasting for 2 days. On rehab admission he complained of double vision and headache. Physical examination showed intact orientation and recall, slight dysarthria (nucleus ambiguous), no aphasia, medial deviation of right eye (CN VI), right sided Horner’s syndrome (central sympathetic fiber), right facial sensory loss (CN V), and right facial paralysis (CN VII), right sided tongue deviation and hearing impairment (CN VIII), left sided proprioception and hemisensory loss (medial lemniscus), 3+/5 strength in left upper and lower extremities (Corticospinal tract), 4/5 in the right upper and lower extremities, brisk tendon reflex in left knee and ankle, and clonus in left ankle. Gait was severely ataxic, and sitting balance was poor. Patient showed good improvement of dysarthria, ataxia, tongue deviation and muscle strength. Dysmetria and strength improved more in right side.
In 1858 Foville described a case of pontine stroke presenting with conjugate ocular deviation to the left, left sided facial paralysis, right hemiplegia and vomiting. Our case is a necessary surgically induced Foville’s syndrome plus showing marked improvement of ataxia, dysarthria and muscle strength.
Post-surgical Foville’s syndrome is a rare condition that shows better functional recovery than following diagnoses, e.g., ischemia stroke, or hemorrhage in the pons. Improvement of adjacent brain tissue edema, recovery of stunned neurons and faster recovery pattern from diaschisis may explain our findings.
Eric L Altschuler– Associate Chief, Residency Program Director, Metropolitan Hospital
SM Mohar– Resident Physician, New York Medical College/Metropolitan Hospital
Xiaofang Wei– Pediatric attending physiatry, Blythedale Children's Hospital
Ruth Alejandro– Pediatric Physiatry Attending, Blythedale Children Hospital
Kristopher Kahle– Neurosurgeon, Yale Haven Hospital