Editors' note: Teaching Video NeuroImages: Pulsatile proptosis and wall-eyed bilateral internuclear ophthalmoplegia

Commenting on “Teaching Video NeuroImages: Pulsatile proptosis and wall-eyed bilateral internuclear ophthalmoplegia,” Lee et al. offer an alternative interpretation of the MRI findings. They explain that the lesion suggested by the authors is chronic in nature and too anterior in the pons. They propose that the more likely explanation for the patient's wall-eyed bilateral internuclear ophthalmoplegia is the symmetric high-signal intensity lesions just beneath the facial colliculi. Authors Papageorgiou et al. reviewed the diffusion-weighted MRI of their patient and found that it showed a focal area of restricted diffusion at the midline of the pontine tegmentum beneath the floor of the fourth ventricle, which involves the medial longitudinal fasciculus bilaterally as correctly suggested by Lee et al. A correction appears on page 900. Commenting on “Teaching Video NeuroImages: Pulsatile proptosis and wall-eyed bilateral internuclear ophthalmoplegia,” Lee et al. offer an alternative interpretation of the MRI findings. They explain that the lesion suggested by the authors is chronic in nature and too anterior in the pons.