Conjugate deviation of the eyes is of help in determining the locus of lesion in brain stem. Herein, we report a 70-year-old male with acute vertigo, blurred vision, and diplopia, accompanied by right internuclear ophthalmoplegia for two days. A battery of electrophysiological examinations including auditory brain stem response, vestibular evoked myogenic potentials and electronystagmography revealed the lesion located on the right medial longitudinal fasciculus including both upper and lower brain stem. Magnetic resonance imaging disclosed a high intensity area in the right pontine area indicating brain stem hemorrhage. All of the symptoms subsided after two months conservative treatment.
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