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Here is presented the case of a unilateral internuclear ophthalmoplegia (INO) with concomitant skew deviation, contralesional exotropia and ipsiversive torsional nystagmus as the initial and only presenting feature of an isolated pontine stroke<jats:italic>.<\/jats:italic> This case illustrates the need to consider a cerebrovascular event early in the differential of a complex ocular motility disturbance not in keeping with specific cranial nerve palsy. It similarly highlights non-paralytic pontine exotropia and skew deviation as important causes of acute onset acquired strabismus, and transient torsional nystagmus as a rare but relevant localising feature in pontine strokes causing INO. Acute onset of this constellation of signs is highly suggestive of pontine infarction.<\/jats:p>","DOI":"10.1136\/bcr-2016-216503","type":"journal-article","created":{"date-parts":[[2016,7,22]],"date-time":"2016-07-22T12:34:57Z","timestamp":1469190897000},"page":"bcr2016216503","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Unilateral internuclear ophthalmoplegia, strabismus and transient torsional nystagmus in focal pontine infarction"],"prefix":"10.1136","volume":"2016","author":[{"given":"Ali S","family":"Haider","sequence":"first","affiliation":[{"name":"John Hunter Hospital, Newcastle, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2016,7,22]]},"reference":[{"key":"2025082700381030000_2016.jul22_2.bcr2016216503.1","doi-asserted-by":"publisher","DOI":"10.1186\/1756-0500-7-728"},{"key":"2025082700381030000_2016.jul22_2.bcr2016216503.2","doi-asserted-by":"publisher","DOI":"10.1586\/17469899.4.1.1"},{"key":"2025082700381030000_2016.jul22_2.bcr2016216503.3","doi-asserted-by":"publisher","DOI":"10.1212\/01.WNL.0000123093.37069.6D"},{"key":"2025082700381030000_2016.jul22_2.bcr2016216503.4","first-page":"214","article-title":"Pure isolated unilateral internuclear ophthalmoplegia from ischemic origin: report of a case and literature review","volume":"105","author":"Deleu","year":"2005","journal-title":"Acta Neurol Belg"},{"key":"2025082700381030000_2016.jul22_2.bcr2016216503.5","first-page":"271","article-title":"Internuclear ophthalmoplegia and torsional nystagmus: an MRI correlate","volume":"51","author":"Srivastava","year":"2003","journal-title":"Neurol India"},{"key":"2025082700381030000_2016.jul22_2.bcr2016216503.6","doi-asserted-by":"publisher","DOI":"10.1007\/BF00900500"},{"key":"2025082700381030000_2016.jul22_2.bcr2016216503.7","doi-asserted-by":"publisher","DOI":"10.1001\/archneur.1991.00530240110032"},{"key":"2025082700381030000_2016.jul22_2.bcr2016216503.8","doi-asserted-by":"publisher","DOI":"10.1159\/000309328"},{"key":"2025082700381030000_2016.jul22_2.bcr2016216503.9","first-page":"446","article-title":"Internuclear ophthalmoplegia associated with transient torsional nystagmus","volume":"101","author":"Lin","year":"2002","journal-title":"J Formos Med Assoc"},{"key":"2025082700381030000_2016.jul22_2.bcr2016216503.10","doi-asserted-by":"publisher","DOI":"10.1016\/j.jns.2015.04.017"},{"key":"2025082700381030000_2016.jul22_2.bcr2016216503.11","first-page":"219","article-title":"Paralytic and non-paralytic pontine exotropia","volume":"139","author":"Bogousslavsky","year":"1983","journal-title":"Rev Neurol (Paris)"},{"key":"2025082700381030000_2016.jul22_2.bcr2016216503.12","doi-asserted-by":"publisher","DOI":"10.1076\/noph.19.1.33.3691"},{"key":"2025082700381030000_2016.jul22_2.bcr2016216503.13","doi-asserted-by":"crossref","unstructured":"Wong AM . 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