Insight Into Uncommon Territory: Exploring Internuclear Ophthalmoplegia in Artery of Percheron Infarct

Area of Science:

• Neurology
• Neuroimaging
• Stroke Syndromes

Background:

• Internuclear ophthalmoplegia (INO) is a horizontal gaze palsy caused by medial longitudinal fasciculus lesions.
• INO presents with diplopia, impaired adduction, and abducting nystagmus, with diverse etiologies like MS and infections.
• Artery of Percheron (AOP) infarction, a rare bilateral thalamic infarct, presents with varied neurological deficits, including oculomotor dysfunction.

Observation:

• A 53-year-old female presented with INO symptoms, including nystagmus, anisocoria, and bilateral ptosis.
• Magnetic resonance imaging revealed an acute infarct in the AOP territory, affecting the rostral midbrain and paramedian thalami.

Findings:

• The patient's INO was attributed to an AOP infarct, a rare cause of thalamic stroke.
• This case underscores the diagnostic challenges posed by AOP infarction's non-specific clinical manifestations.

Implications:

• Meticulous clinical assessment and advanced neuroimaging are crucial for diagnosing rare stroke syndromes like AOP infarction.
• Prompt diagnosis and management, including antiplatelet therapy and supportive care, are vital for improving patient outcomes.
• Enhanced understanding of uncommon stroke syndromes and continued research are essential for advancing diagnostic accuracy and treatment efficacy.