Effects of Eye Movement Training and Changes of Gaze During Walking in a Patient With Oculomotor Disorder After Brainstem Hemorrhage.

We report a case of a patient who developed pontine hemorrhage and presented with eye movement disorders but was able to regain conjugate eye movement through eye movement training, resulting in improved walking ability.  The patient was a 39-year-old man who presented with cerebral hemorrhage. He was admitted to the hospital due to a pontine hemorrhage extending from the midbrain to the medulla oblongata and perforation of the fourth ventricle. Symptoms included right hemiplegia, right upper and lower limb paresthesias, ataxia of the trunk, left abducens nerve palsy, left facial nerve palsy, right oculomotor nerve palsy, right trochlear nerve palsy, right Horner's syndrome, and longitudinal nystagmus. From the 121st day, eye movement training was performed for five days per week for 10 weeks to treat oculomotor dysfunction. For eye movement evaluation, left and right eye movements during pursuit eye movement, which involved following the contours of a figure, and during walking were measured with an eye movement measuring device (eye camera) (TalkEye Light; Takei Kiki Co. Ltd., Japan). In addition, motor function assessment included ataxia, lower limb muscle strength, physical balance function, and walking ability. Measurements were taken before the start of the eye movement training, two weeks after walking ability improved, and then at 10 weeks. After 10 weeks of eye movement training, the range of motion of the eyeballs during pursuit eye movement was expanded, and both eyes moved in the same direction and by the same amount. The eyes moved similarly to those of a healthy subject during walking two weeks and 10 weeks after the start of eye movement training, when walking ability improved, the left and right gazes overlapped, and both eyes were focused on the center of the forward visual field. Motor function improved in all categories. The eye movement training improved eye movements, and strabismus and diplopia were no longer observed. We suggest that eye movement training, in addition to conventional motor training, may be a means to improve walking ability in stroke patients in order to obtain a stable gait.