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NEUROLOGY 1994;44:2032
© 1994 American Academy of Neurology

Pure midbrain infarction

Clinical syndromes, MRI, and etiologic patterns

Julien Bogousslavsky, MD, Philippe Maeder, MD, Franco Regli, MD and Reto Meuli, MD

Departments of Neurology (Drs. Bogousslavsky and Regli) and Radiology (Drs. Maeder and Meuli), University Hospital, Lausanne, Switzerland.

We studied 22 patients with first stroke and infarct limited to the midbrain on MRI. We selected these patients (8%) from 281 with posterior circulation infarct admitted consecutively into a primary care center. All patients underwent a systematic protocol of investigations including MR imaging and angiography, and echocardiography. Most infarcts fitted well to arterial territories drawn in preestablished templates. Middle midbrain involvement was the most common, mainly in the paramedian territory supplied by the basilar artery. Infarct in the mesencephalic territory of the posterior cerebral artery was less common, while superior cerebellar artery territory infarct was extremely rare, and posterior choroidal artery territory infarct did not occur. The neurologic picture was dominated by eye-movement disorders. Patients with isolated upper or lower midbrain infarct had no localizing clinical findings, but patients with middle midbrain infarct had a localizing picture mainly with nuclear or fascicular third nerve palsies that commonly developed in isolation. Vertical gaze paresis, pure motor hemiparesis, four-limb ataxia from unilateral lesion, and hypesthetic ataxic hemiparesis also occurred. Contrary to a common view, cardioembolism was not a more common etiology than basilar artery stenosis or small-vessel disease.

Address correspondence and reprint requests to Dr. Julien Bogousslavsky, Service de Neurologie, CHUV, CH-1011, Lausanne, Switzerland.

Received March 9, 1994. Accepted in final form May 13, 1994.




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