Astasia, asymmetrical asterixis and pretectal syndrome in thalamo-mesencephalic hemorrhage.
We report a patient who presented with sudden onset instability and diplopia. On neurological examination he had asymmetrical asterixis, predominantly in the left hand, and ocular findings consistent with a pretectal syndrome. He was also unable to stand or even sit up unassisted, with a tendency to tilt his body and rotate his trunk axis to the left. Brain MRI showed a hemorrhage in the right thalamo-mesencephalic junction. This region involves important structures for the control of postural stability, motor control, ocular movements and vestibulo-ocular integration, not yet well understood. To our knowledge, this is the first reported case with the simultaneous combination of astasia, prectectal syndrome and asymmetrical asterixis.
de Pablo-Fernández
Eduardo
E
Department of Neurology, Hospital Universitario Doce de Octubre, Carretera de Andalucía Km 5,4, 28041 Madrid, Spain. edudepablo@hotmail.com
Villarejo
Alberto
A
Domínguez-González
Cristina
C
Hidalgo
Fernando Sierra
FS
Callero
Elisa Correas
EC
D004172:Diplopia / Q000150:complications; D020820:Dyskinesias / Q000209:etiology* / Q000523:psychology; D006801:Humans; D020300:Intracranial Hemorrhages / Q000150:complications* / Q000523:psychology; D008297:Male; D008636:Mesencephalon; D008875:Middle Aged; D009460:Neurologic Examination; D013788:Thalamus