Bilateral third nerve palsy in basilar vertebral artery disease. Report of three cases with survival and review of the literature

Abstract

. The authors describe three patients with rare bilateral third nerve palsy due to midbrain infarction involving both oculomotor nuclei and intramedullary nerve fascicles. All survived the acute ischemic event but while recovering exhibited in addition to their disabling oculomotor and spastic deficit distinct signs of organic mental syndrome due to both additional thalamic lesions and interruption of mesencephalic tracts joining the midbrain to the limbic system. It can be assumed that in future we will more often encounter this typical vascular rostral brainstem syndrome, since neurological intensive care units and the use of interventional recanalizing neuroradio-logical techniques will allow better prognosis in severe basilar artery disease.