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Midbrain ischemia presenting as vertical gaze palsy: value of diffusion-weighted magnetic resonance imaging
T Seifert1, C Enzinger, S Ropele
1Department of Neurology, Karl Franzens University, Graz, Austria. thomas.seifert@uni-graz.at
Background:
Conventional magnetic resonance imaging may fail to identify very small but clinically relevant acute subcortical brain infarcts. Diffusion-weighted magnetic resonance imaging (DWI) is very sensitive and specific for acute cerebral ischemia and should contribute to the early detection of such lesions.
Methods:
We analyzed 6 patients who presented with acute vertical gaze palsy and in whom DWI was performed within 1-6 days from symptom onset.
Results:
DWI accurately identified ischemia in an area supplied by the posterior thalamosubthalamic paramedian artery in all patients. T(2)-weighted and FLAIR imaging failed to identify the clinically relevant lesion in 2 and 3 patients, respectively.
Conclusion:
DWI improves the clinicoanatomical correlation in patients presenting with supranuclear oculomotor disturbances.
