A Case of Return to Driving by Successful Oculomotor Rehabilitation for Ocular Motility Disorder and Diplopia due to Pontine Infarction：The Application of Visual Attention Tasks

Rehabilitation for ocular motility disorder and diplopia after acute cerebral infarction has not been established. In the present case, we describe the course of oculomotor rehabilitation in a patient with left-sided gaze palsy and diplopia due to a stroke in the paramedian part of the left pontine tegmentum. The patient was a right-handed man in his 40s. Cerebral infarction occurred after coil embolization with stenting for an unruptured dissecting aneurysm. He presented with eye movement difficulty resulting from conjugate deviation of the eyes to the right at onset. No other motor-sensory abnormalities were present. Processing speed of Wechsler Adult Intelligence Scale-Fourth Edition was decreased. We performed oculomotor rehabilitation from the acute phase, including fixation, smooth pursuit, saccadic and convergent movements. Visual attention tasks such as visual search and cancellation tasks were applied from 10 days after onset. The oculomotor disorders gradually improved and disappeared by 65 days after onset. The responsible lesion was localized in left paramedian pontine reticular formation and abducens nucleus. Medial longitudinal fasciculus was not involved, which was consistent with the clinical oculomotor findings. The neuropsychological assessments showed that processing speed was improved. Based on the neuropsychological assessments and actual vehicle evaluation, our multidisciplinary team determined that the patient should not refrain from automobile driving. The patient returned to work and resumed driving 86 days after onset. The results suggest that visual attention tasks together with basic oculomotor trainings for ocular motility disorder and diplopia are useful for early return to automobile driving and society.