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Pure midbrain infarction: clinical, radiologic, and pathophysiologic findings
1Department of Neurology, University of Ulsan, Asan Medical Center, Seoul, Korea. jongskim@amc.seoul.kr
Objective:
To describe the clinical features, MRI findings, and the pathogenesis of the pure midbrain infarction.
Methods:
Forty patients with infarcts limited to the midbrain were studied. MRI and angiography (mostly MR angiography) were performed in all patients.
Results:
Clinical manifestations included gait ataxia in 27 (68%) patients, dysarthria in 22 (55%), limb ataxia in 20 (50%), sensory symptoms in 17 (43%), third nerve palsy in 14 (35%), definitive limb weakness (< or =IV/V) in nine (23%), and internuclear ophthalmoplegia in five (13%). According to MRI findings, the lesions were categorized into four groups. The anteromedial group (n = 18) was characterized by oculomotor disturbances (89%), ataxia (89%, bilateral in 17%), and sensory changes (39%) usually restricted to the perioral and hand areas. Lesions restricted to the subcortical area (n = 10) were usually related to small vessel disease (SVD) (78%), whereas those involving the medial surface (n = 8) were caused by large vessel disease (LVD) (78%). The anterolateral group (n = 11) was characterized by ataxia (70%) and definitive hemiparesis (30%) usually caused by LVD (82%). The combined group (n = 6) had frequent oculomotor disturbances (83%), definitive hemiparesis (67%), and ataxia (50%) and was usually associated with LVD (67%). The lateral group (n = 2) was characterized by prominent sensory symptoms. The prognosis was generally good except for one patient with a bilateral lesion.
Conclusion:
Clinical-radiologic correlation study yields four distinct subgroups: anteromedial, anterolateral, combined, and lateral. Large vessel disease and small vessel disease are usual pathogenic mechanisms, whereas cardiogenic embolism is rare.
Insights
Pure midbrain infarction presents with diverse neurological symptoms, often including ataxia and oculomotor disturbances. MRI reveals four distinct lesion patterns, primarily linked to large and small vessel diseases.
Area of Science:
- Neurology
- Radiology
- Vascular Medicine
Background:
- Pure midbrain infarction is a specific type of stroke affecting a critical brain region.
- Understanding its clinical and radiological characteristics is crucial for diagnosis and management.
Purpose of the Study:
- To delineate the clinical features and MRI findings of pure midbrain infarction.
- To investigate the underlying pathogenic mechanisms, including large vessel disease (LVD) and small vessel disease (SVD).
Main Methods:
- Retrospective analysis of 40 patients with infarcts exclusively in the midbrain.
- Utilized Magnetic Resonance Imaging (MRI) and MR angiography for lesion characterization.
Main Results:
- Common symptoms include gait and limb ataxia, dysarthria, sensory disturbances, and third nerve palsy.
- MRI identified four lesion subgroups: anteromedial, anterolateral, combined, and lateral, each with characteristic clinical and etiological profiles.
- Small vessel disease (SVD) was associated with subcortical lesions, while large vessel disease (LVD) was more common in medial and anterolateral infarcts.
Conclusions:
- Pure midbrain infarction can be classified into four distinct clinical-radiological subgroups.
- Large and small vessel diseases are the predominant causes, with cardiogenic embolism being infrequent.
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