Midbrain ischemia presenting as vertical gaze palsy: value of diffusion-weighted magnetic resonance imaging.
BACKGROUND
Conventional magnetic resonance imaging may fail to identify very small but clinically relevant acute subcortical brain infarcts. Diffusion-weighted magnetic resonance imaging (DWI) is very sensitive and specific for acute cerebral ischemia and should contribute to the early detection of such lesions.


METHODS
We analyzed 6 patients who presented with acute vertical gaze palsy and in whom DWI was performed within 1-6 days from symptom onset.


RESULTS
DWI accurately identified ischemia in an area supplied by the posterior thalamosubthalamic paramedian artery in all patients. T(2)-weighted and FLAIR imaging failed to identify the clinically relevant lesion in 2 and 3 patients, respectively.


CONCLUSIONS
DWI improves the clinicoanatomical correlation in patients presenting with supranuclear oculomotor disturbances.
Seifert
T
T
Department of Neurology, Karl Franzens University, Graz, Austria. thomas.seifert@uni-graz.at
Enzinger
C
C
Ropele
S
S
Storch
M K
MK
Fazekas
F
F
D000208:Acute Disease; D000328:Adult; D000368:Aged; D002545:Brain Ischemia / Q000150:complications* / Q000175:diagnosis*; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D008297:Male; D008636:Mesencephalon / Q000098:blood supply*; D009886:Ophthalmoplegia / Q000209:etiology*