Res Vestib Sci.  2021 Jun;20(2):58-63. 10.21790/rvs.2021.20.2.58.

Rare Neuro-Ophthalmological Manifestations of Focal Midbrain Infarction

• Kim JG
• Kang JH
• Choi JC
• Kim HJ
• Kang CH

• KMID: 2516821
• DOI: http://doi.org/10.21790/rvs.2021.20.2.58

Abstract

Because numerous important nuclei and white matter tracts are concentrated in the narrow midbrain, the tiny lesion can result in various symptoms. The anatomy of the neural network and related structures in the midbrain is complex. The most frequent clinical manifestation of lesions involving the midbrain is an eye movement disorder associated with a nuclear or fascicular origin. We have described patients with acute midbrain stroke, characterized by rare neuro-ophthalmologic manifestations, which neurologists should consider during diagnostic investigations. Case 1 showed internuclear ophthalmoplegia with Horner syndrome. In case 2 showed isolated oculomotor palsy. The third patient presented Parinaud syndrome with an unusual lesion location. Notably, patients with midbrain infarction may present with specific signs and symptoms that are compatible with mesencephalic localization. The isolated or combined neuro-ophthalmologic signs and symptoms should be interpreted in the complex anatomical context described here and investigated by immediate brainstem neuroimaging analyses and careful neurologic examinations.

Keyword

Brain stem infarctions; Cerebral infarction; Magnetic resonance imaging; Mesencephalon; Ocular motility disorder; 뇌간 뇌졸중; 뇌경색증; 자기공명영상; 중간뇌; 안구운동장애