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Stroke involving the midbrain and thalamus and causing 'nonfocal' coma
1Department of Medicine (Neurology), Royal University Hospital, University of Saskatchewan, Saskatoon, Canada.
Southern Medical Journal
|January 1, 1992
Summary
Ischemic stroke in the midbrain and thalamus can cause coma. Abnormal vertical eye movements are key to diagnosing this stroke early, preventing misdiagnosis of metabolic encephalopathy or drug overdose.
Area of Science:
- Neurology
- Neuroscience
- Stroke Medicine
Background:
- Coma presentation without focal neurological deficits can be challenging to diagnose.
- Metabolic encephalopathy and drug overdose are common initial considerations for undifferentiated coma.
Observation:
- Two patients presented with coma and no focal neurological findings.
- Abnormal vertical eye movements were noted in both patients.
Findings:
- Ischemic stroke involving the midbrain and thalamus was diagnosed in both patients.
- The abnormal vertical eye movements were a crucial diagnostic clue.
Implications:
- Early recognition of abnormal vertical eye movements can aid in diagnosing midbrain-thalamic ischemic stroke.
- This diagnostic approach may prevent unnecessary investigations for metabolic encephalopathy or drug overdose.
- Clinical examination of eye movements is vital in evaluating comatose patients.