Bilateral horizontal gaze palsy caused by a primary pontine hemorrhage in an alert patient

Bilateral horizontal gaze palsies are rare, and we are aware of only I previously reported case that was due to a primary pontine hemorrhage (PPH). We report a 2nd patient with a primary pontine tegmental hemorrhage resulting in bilateral horizontal gaze palsy hut preserved consciousness. Our case confirms that bilateral horizontal gaze palsies can result from a discrete PPH detected by MRI and that PPH should be considered in the differential diagnosis of this rare and selective ophthalmoplegia. In addition, an attempt is made to explain the disparity between the unimpaired consciousness in this patient and such a pontine lesion.