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We prospectively examined 11 patients with magnetic resonance imaging- documented infarction in the paramedian thalamopeduncular region,which is supplied by the superior mesencephalic and posterior thalamosubthalamic arteries.Variations in the size and rostral-caudal extent of infarction correlated with the following three clinical patterns:(1)With unilateral paramedian mesencephalic infarction,an ipsilateral third nerve paresis was accompanied by mild contralateral hemiparesis or hemiataxia.Contralateral ptosis and impaired upgaze were observed in two patients;one of them showed additional damage to the posterior commissure.(2)With bilateral infarction in the thalamopeduncular junction,involving the mesencephalic reticular formation,supranuclear vertical gaze defects were accompanied by impaired consciousness or memory,and mild aphasia in some patients. Persistent amnesia was observed only when the dominant anterior nucleus or mamillothalamic tract was damaged.(3)With larger thalamopeduncular infarcts,partial or complete third nerve paresis was combined with supranuclear gaze disturbance and delayed contralateral tremor.An unusual gaze disorder,a variant of the vertical"one-and-a-half syndrome,"occurred with a small strategically placed lesion at the thalamopeduncular junction,best explained by selective damage to supranuclear pathways or partial nuclear involvement.The primary cause of these infarctions was embolism to the basilar apex or local atheroma at the origin of the posterior cerebral artery. |
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cerebral embolism
eye movement,disorders of
gaze palsy,supranuclear
hemiparesis
hypersomnia
level of consciousness,decreased
memory,impairment of
mesencephalic artery syndrome
midbrain,infarction of
MRI
MRI,abnormal
ocular motility,disorders of
thalamus,infarction of
thalamus,lesion of-bilateral
third nerve palsy
third nerve palsy,bilateral
transient neurologic deficit
tremor
tremor,thalamic
unconsciousness
unconsciousness,transient
upgaze,paralysis of
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