Objective: To report and analyze the clinical and imaging features of a case of anterior internuclear ophthalmoplegia caused by pontine punctate infarction, in order to raise the attention of the clinical physician.

Methods: Through in-depth analysis of a patient with anterior internuclear ophthalmoplegia caused by pontine point infarction, this study elucidates the mechanism of its clinical symptoms, enhances the anatomical understanding of various nerve fiber bundles in the brainstem,and guides clinical diagnosis and treatment.

Results: A 67-year-old woman was admitted to hospital complaining of "feeling vertigo for more than 11 hours". Physical examination on admission revealed that she could not adduct her right eye, and she had nystagmus. Her head MRI indicated infarction of the right pontine. She had been diagnosed with pontine infarction and treated by aspirin,clopidogrel, atorvastatin, butylphthalide, betamethasone, and so on. The symptoms improved and the patient was discharged. After one month of follow-up, the patient's symptoms returned to normal.

Conclusion: The structure of the brainstem is complex and precise, with frequent damage to adjacent nerve nuclei and fiber bundles. There are few reports of brainstem point like infarcts involving only the medial longitudinal fasciculus (MLF). Therefore, frontline doctors should enhance their understanding of the anatomy of various nerve fiber bundles in the brainstem, pay attention to clinical examination, and avoid misdiagnosis and missed diagnosis.