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Oculomotor nuclear complex infarction. Clinical and radiological correlation.

J Biller, R Shapiro, L S Evans

    Archives of Neurology
    |September 1, 1984
    PubMed
    Summary

    A rare stroke affecting the midbrain caused specific eye movement and eyelid control issues after heart surgery. This case highlights a unique embolic stroke mechanism impacting the oculomotor system.

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    Area of Science:

    • Neurology
    • Neuroimaging
    • Ophthalmology

    Background:

    • Percutaneous transluminal coronary angioplasty (PTCA) is a common cardiac procedure.
    • Mesencephalic infarcts are rare, with dorsal tegmental lesions being exceptionally uncommon.

    Observation:

    • A patient developed bilateral ptosis, internuclear ophthalmoplegia, and convergence retractory nystagmus post-PTCA.
    • High-resolution computed tomography (CT) revealed an isolated dorsal tegmental infarct of the midbrain.

    Findings:

    • The infarct affected the oculomotor nuclear complex and medial longitudinal fasciculus.
    • Findings suggest a caudal, dorsal, paramedian embolic infarct in the mesencephalic artery territory.
    • Correlated with Warwick's scheme for oculomotor subnuclei localization.

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    Implications:

    • This case expands the understanding of stroke mechanisms following cardiac interventions.
    • It provides a detailed clinicoradiological correlation of a rare mesencephalic infarct.
    • Highlights the importance of considering specific neurovascular territories in embolic stroke events.