The described brain changes, especially the temporal lobe white matter involvement and the sparing of the subcortical U-fibers, are consistent with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL).

The infarction seen at the medial longitudinal fasciculus (which coordinates movements of the eyes with movements of the head) can explain the patient's presentation.

Case courtesy: Prof. Dr. Yasser Ragab