Abstract
We present a 41-year-old HIV-positive female patient complaining of complete right palpebral ptosis, diplopia, and inability to balance herself. On examination, the right eye was able to move laterally and downwards. The motor exam showed left hemiparesis (4/5) on upper and lower limbs, bilateral Babinski sign with left hemiataxia without the sensory disorder. A computed tomography (CT) angiogram confirmed a diffuse vasculitis with parenchymal changes in the right thalamus and midbrain. CT scan and magnetic resonance imaging angiography demonstrated an ischemic infarct on the right paramedian branch of the posterior cerebral artery territory. This patient did not present clinical manifestations of the thalamic lesion. To our knowledge, this is the first reported case of a young patient presenting a unilateral thalamomesencephalic ischemic stroke secondary to HIV vasculitis with bilateral Babinski signs and without thalamic signs in the medical literature.
Highlights
In 2018, Sato et al reported a 62-year-old man presenting with a rare eye movement
Because the artery of Percheron occlusion can affect the thalamus and midbrain at the same time, here we have to mention that artery of Percheron is an uncommon vascular variant of the paramedian branches of the posterior cerebral artery, arising from one P1 segment, bifurcates, and bilateral supply to the bilateral paramedian thalami and the rostral midbrain[10,11] but not unilaterally
Here we report a case of a 41-year-old woman with rightsided thalamomesencephalic stroke (TMS)
Summary
In 2018, Sato et al reported a 62-year-old man presenting with a rare eye movement This patient had a vertical one-anda-half syndrome caused by unilateral thalamomesencephalic stroke (TMS)[1]. Other clinical presentations of TMS include see-saw nystagmus that shows intorsion and elevation of one eye, with synchronous extorsion and depression on the contralateral one, convergence-retraction nystagmus and contraversive ocular tilt reaction probable due to ischemic involvement of the interstitial nucleus of Cajal[27], anisocoria. Another author found vertical ocular motor disturbances in the vertical plane and eye movement synkinesis, hypersomnia, and coma as a clinical manifestation of TMS28. She was referred to her base hospital to continue rehabilitation and a follow-up date with us in 1 month
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