Case Report: Thalamomesencephalic stroke in a patient with HIV

Jerry George,Sibi Joseph,Thozama Dubula,Mongezi Tau,Lourdes De Fatima Ibanez Valdes,Humberto Foyaca-Sibat

doi:10.12688/f1000research.26722.3

Jerry George, Sibi Joseph + Show 4 more

Open Access

https://doi.org/10.12688/f1000research.26722.3

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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. 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

We present a 41-year-old HIV-positive female patient complaining of complete right palpebral ptosis, diplopia, and inability to balance herself
Computed tomography (CT) angiogram and MRI showed diffuse vasculitis with parenchymal changes seen in the right thalamus and midbrain and hyperdensity lesion (T2- weighted/FLAIR MRI images) secondary to ischemic infarct in the area supplied by the right paramedian branch of the posterior cerebral artery due to vasculitis (Figure 2–Figure 4)
Here we report a case of a 41-year-old woman with rightsided thalamomesencephalic stroke (TMS)

Summary

16 Oct 2020 report

Any further responses from the reviewers can be found at the end of the article Introduction 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]. Computed tomography (CT) angiogram and MRI (done two days after admission) showed diffuse vasculitis with parenchymal changes seen in the right thalamus and midbrain and hyperdensity lesion (T2- weighted/FLAIR MRI images) secondary to ischemic infarct in the area supplied by the right paramedian branch of the posterior cerebral artery due to vasculitis (Figure 2–Figure 4).

Discussion

Anghelescu A

10. Percheron G

21. Caballero PEJ

Findings

23. Song YM