Central Horner's syndrome with contralateral ataxic hemiparesis: a diencephalic alternate syndrome.
OBJECTIVE
To assess whether thalamic strokes presenting with a central Horner's syndrome (HS) show specific clinicoanatomic patterns.


METHODS
From the Lausanne Stroke Registry (period 1993 to spring 2002), the authors selected all patients with thalamic stroke presenting with ipsilateral HS. Patients with complete infarction of the posterior cerebral artery territory, with involvement of middle cerebral artery territory or bilateral lesions, were excluded. Lesions on brain MRI were correlated with standard neuroanatomic templates.


RESULTS
Nine patients with thalamic infarction presenting with central HS were found; all showed contralateral ataxic hemiparesis (AH). Lesions involved the anterior or paramedian thalamus and extended to the hypothalamic or rostral paramedian mesencephalic area in all but one subject. Associated clinical signs included dysphasia (two patients), somnolence (six), vertical gaze paresis (two), asterixis (two), and hemihypesthesia (three).


CONCLUSIONS
The alternate clinical pattern of central HS with contralateral AH is a stroke syndrome of the diencephalic-mesencephalic junction, resulting from the involvement of the common arterial supply to the paramedian/anterior thalamus, the posterior hypothalamus and the rostral paramedian midbrain.
Rossetti
Andrea O
AO
Service de neurologie, CHUV, Lausanne, Switzerland. Andrea.Rossetti@chuv.hospvd.ch
Reichhart
Marc D
MD
Bogousslavsky
Julien
J
D000328:Adult; D000368:Aged; D001259:Ataxia / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D004027:Diencephalon / Q000503:physiopathology*; D005260:Female; D007839:Functional Laterality; D006732:Horner Syndrome / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010291:Paresis / Q000175:diagnosis / Q000209:etiology*; D011446:Prospective Studies; D012042:Registries / Q000706:statistics & numerical data; D012189:Retrospective Studies; D020521:Stroke / Q000150:complications; D013788:Thalamus / Q000098:blood supply / Q000503:physiopathology; D014057:Tomography, X-Ray Computed