Attentional Deficit as the Primary Manifestation of an Isolated Midbrain Infarction

A prominent attentional deficit is an uncommon primary manifestation of an isolated midbrain infarction. We present the case of a 62-year-old man with an acute right midbrain infarct who presented with a marked attentional deficit, observed as repeated forgetting to flush the toilet. His classical neurological signs, including mild ataxia and dysarthria, were minor compared with his functionally impaired cognitive dysfunction. This case illustrates a potential dissociation between motor signs and cognitive impairment in patients with midbrain lesions and emphasizes the value of performing a neuropsychological assessment to identify less apparent disabilities and facilitate appropriate intervention.