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Unilateral third nerve palsy and somnolent mutism
Journal of Clinical Neuro-Ophthalmology
|June 1, 1987
Summary
A unilateral midbrain infarct caused somnolent mutism and third nerve palsy in a 64-year-old man. This case report highlights a rare presentation of brainstem stroke, challenging previous lesion localization theories.
Area of Science:
- Neurology
- Neuroimaging
- Stroke Medicine
Background:
- Somnolent mutism is typically associated with bilateral midbrain or thalamic lesions.
- Previous case reports have established a pattern of bilateral tegmental tegmentum involvement.
Observation:
- A 64-year-old male presented with acute onset unilateral third nerve palsy and somnolent mutism.
- Computed tomography (CT) identified a small, unilateral infarct in the midbrain.
Findings:
- This is the first reported case of somnolent mutism attributed to a unilateral midbrain infarct.
- High-resolution CT imaging facilitated precise localization of the brainstem lesion.
Implications:
- The findings suggest that unilateral midbrain lesions can induce somnolent mutism, expanding the known etiological spectrum.
- This case underscores the importance of detailed neuroimaging in diagnosing rare stroke presentations and refining understanding of brainstem circuitry.