Ramakrishnan Subasree, Narayanaswamy Veera Rajkumar
Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India.
J Neurosci Rural Pract. 2013 Apr;4(2):220-3. doi: 10.4103/0976-3147.112775.
A 42-year-old young lady presented with acute onset of dizziness, drooping of left eye with binocular diplopia and inability to walk unassisted. She had past history of uncontrolled diabetes mellitus and hypertension. On examination, she had left fascicular type of third nerve palsy, vertical one and half syndrome (VOHS), left internuclear ophthalmoplegia and skew deviation with ipsilesional hypertropia. She also had thalamic astasia and right unilateral asterixis. Her MRI revealed T2 and Flair hyper intense signal changes with restricted diffusion in the left thalamus, subthalamus and left midbrain. MR Angiography was normal. Thalamic-subthalamic paramedian territory infarct is relatively uncommon. It can present with oculomotor abnormalities including vertical one and half syndrome, skew deviation, thalamic astasia and asterixis. This case is reported for the rarity of the presenting clinical findings in unilateral thalamo-mesencephalic infarcts.
一名42岁年轻女性因急性起病的头晕、左眼下垂伴双眼复视及无法独立行走就诊。她既往有未控制的糖尿病和高血压病史。体格检查发现，她存在左侧束状型动眼神经麻痹、垂直一个半综合征（VOHS）、左侧核间性眼肌麻痹以及同侧眼位高的斜视。她还存在丘脑性站立不能及右侧单侧扑翼样震颤。她的磁共振成像（MRI）显示左侧丘脑、下丘脑及左中脑T2加权像和液体衰减反转恢复序列（Flair）呈高信号改变，伴扩散受限。磁共振血管造影正常。丘脑 - 下丘脑旁正中区域梗死相对少见。它可表现为动眼神经异常，包括垂直一个半综合征、斜视、丘脑性站立不能及扑翼样震颤。报道该病例是因为单侧丘脑 - 中脑梗死出现的这些临床表现罕见。
