An unusual presentation of ischemic stroke

A 67-year-old man with history of diabetes mellitus and arterial hypertension, presented with sudden diplopia and gait disturbance. Physical examination showed truncal instability and dysmetria of left limbs, associated with signs of left unilateral internuclear ophtalmoplegia (INO), without impairment of convergence (A, B). Two days later, Brain MRI showed a small ischemic stroke involving the paramedian tegmentum of the left ponto-mesencephalic junction (C, D). The stroke was secondary to the atherosclerosis process. The patient was treated with 160mg/j of aspirin. The follow up at 10 days was marked with little attenuation of neurological signs.