tailieunhanh - báo cáo khoa học: "Unilateral thalamic infarction presenting as vertical gaze palsy: a case report"

Tuyển tập báo cáo các nghiên cứu khoa học quốc tế ngành y học dành cho các bạn tham khảo đề tài:Unilateral thalamic infarction presenting as vertical gaze palsy: a case report | Khan et al. Journal of Medical Case Reports 2011 5 535 http content 5 1 535 JOURNAL OF MEDICAL CASE REPORTS CASE REPORT Open Access Unilateral thalamic infarction presenting as vertical gaze palsy a case report Muhib Khan Christos Sidiropoulos and Panayiotis Mitsias Abstract Introduction Vertical gaze palsy is a recognized manifestation of midbrain lesions. It rarely is a consequence of unilateral thalamic infarction. Case presentation We report the case of a 48-year-old African-American woman who presented to our facility with vertical gaze palsy and evidence of left medial thalamic infarct on diffusion-weighted imaging without coexisting midbrain ischemia. The etiology of infarct was determined to be small vessel disease after extensive investigation. Conclusions This report suggests a possible role of the thalamus as a vertical gaze control center. Clinicoradiological studies are needed to further define the role of the thalamus in vertical gaze control. Introduction Vertical gaze palsy is usually associated with lesions of the mesencephalic rostral interstitial nucleus of the medial longitudinal fasiculus the interstitial nucleus of Cajal the posterior commissure and the peri-aqueductal gray matter. Rarely vertical gaze palsies can be a manifestation of paramedian thalamic infarction 1-3 . Here we describe the case of a patient presenting with upward gaze palsy secondary to isolated medial thalamic infarct. Case presentation A 48-year-old African-American woman with diabetes hypertension and hyperlipidemia presented to our facility with acute onset of dizziness and vertical diplopia. A physical examination revealed upward gaze paresis which could be overcome by the doll s eye maneuver and skew deviation of the right eye. A magnetic resonance imaging MRI scan which was performed 12 hours after the onset of symptoms showed an acute left paramedian thalamic infarct Figure 1 Figure 2 and 3 without associated midbrain lesions Figure 4 and

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