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Updated: May 9, 2026
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Permanent Cerebral Vessel Occlusion via Double Ligature and Transection
Published on: July 21, 2013
Pure midbrain ischemia and hypoplastic vertebrobasilar circulation.
Nicola Gilberti1, Massimo Gamba, Angelo Costa
1Stroke Unit, U.O. Neurologia Vascolare, Spedali Civili di Brescia, P.le Spedali Civili, 1, Brescia, Italy, nicgilbe@tin.it.
Summary
Isolated midbrain infarction is rare. Small vessel disease is the main cause, and vertebrobasilar circulation abnormalities are common. Most patients achieve good functional outcomes.
Area of Science:
- Neurology
- Vascular Neurology
- Neuroimaging
Background:
- Isolated midbrain infarction is an uncommon condition with poorly understood etiology and long-term patient outcomes.
- Posterior circulation vascular abnormalities are implicated but require further investigation.
Purpose of the Study:
- To describe clinical features, etiologies, and outcomes of isolated midbrain infarction.
- To investigate the association between midbrain infarction and posterior circulation vascular anomalies.
Main Methods:
- Retrospective analysis of patients with first acute ischemic stroke limited to the midbrain.
- Recording of demographic data, neurological symptoms, neuroimaging findings, and cardiovascular risk factors.
- Functional outcome assessment using the modified Rankin Scale at discharge and 3-month follow-up.
Main Results:
- Nine patients with acute isolated midbrain infarction were identified (0.61% of ischemic strokes).
- Small-vessel disease was the predominant cause (88.8%).
- Common symptoms included gait impairment (44.4%) and third-nerve palsy (55.5%). Vascular anomalies of the vertebrobasilar system, particularly vertebral artery hypoplasia (44.4%), were frequent (77.7%).
- Most patients (77.7%) achieved good functional outcomes at 3 months, with no recurrences.
Conclusions:
- Isolated midbrain infarction, often caused by small-vessel disease, is associated with specific clinical signs like third-nerve palsy.
- Vertebrobasilar circulation abnormalities, including hypoplastic arteries, are frequently observed and may predispose to this type of stroke.
- Patients generally experience good functional recovery, highlighting the importance of identifying underlying vascular factors.
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