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Midbrain ptosis caused by periaqueductal infarct following cardiac catheterization: early detection with
M Mihaescu1, J Brillman, W Rothfus
1Department of Neurology, Allegheny General Hospital, Pittsburgh, Pennsylvania 15212, USA.
Abstract:
Isolated infarcts in the periaqueductal region are rare but have been reported after cardiac catheterization. The authors report a case of dorsal midbrain infarct which caused bilateral ptosis, partial upgaze paresis, and internuclear ophthalmoplegia imaged within eight hours with diffusion-weighted imaging (DWI). The lesion was later confirmed on T2-weighted images. Diffusion-weighted imaging can rapidly confirm the diagnosis of this rare brain-stem infarct.
Insights
Isolated midbrain infarcts, though rare after cardiac procedures, can cause vision and eyelid issues. Diffusion-weighted imaging (DWI) rapidly diagnoses these brainstem infarcts.
Area of Science:
- Neuroimaging
- Neurology
- Vascular Neurology
Background:
- Periaqueductal region infarcts are uncommon but documented following cardiac catheterization.
- Dorsal midbrain infarcts present with specific ophthalmological signs.
Observation:
- A case of dorsal midbrain infarct presented with bilateral ptosis, impaired upgaze, and internuclear ophthalmoplegia.
- Symptoms were observed in a patient following cardiac catheterization.
Findings:
- Diffusion-weighted imaging (DWI) successfully visualized the infarct within eight hours of symptom onset.
- The lesion was subsequently confirmed using T2-weighted imaging.
Implications:
- DWI is a crucial, rapid diagnostic tool for rare brainstem infarcts.
- Early diagnosis facilitates timely management of midbrain infarct complications.
