title: Concomitant presentation of three rare mesencephalic syndromes: case report.
abstract: We describe a unique case of concomitant presentation of three rare mesencephalic syndromes. A 48-year-old man with an acute stoke was found to have an unusual combination of three rare mesencephalic syndromes after detailed neuro-ophthalmic evaluation: the plus-minus lid syndrome, the vertical one-and-a-half syndrome, and Claude's syndrome. We discuss the clinical and anatomical localization of these syndromes. This was corroborated by magnetic resonance imaging (MRI) which revealed areas of infarction at the thalamo-mesencephalic junction and the right rostral midbrain involving the third nerve fascicle and the red nucleus. Our case highlights the importance of a careful ocular motility examination as a tool which has a highly localizing value in the diagnosis of stroke.
authors.affiliation: Department of Ophthalmology, University of Washington, Seattle, WA, USA. drsrandhawa@gmail.com
authors.forename: Sandeep
authors.initials: S
authors.lastname: Randhawa
authors.forename: Megan M
authors.initials: MM
authors.lastname: Donohue
authors.forename: Steven R
authors.initials: SR
authors.lastname: Hamilton
mesh_terms: D020526:Brain Stem Infarctions / Q000150:complications* / Q000473:pathology; D002544:Cerebral Infarction / Q000150:complications* / Q000473:pathology; D005141:Eyelid Diseases / Q000150:complications* / Q000473:pathology; D006801:Humans; D008297:Male; D008636:Mesencephalon / Q000473:pathology*; D008875:Middle Aged; D015840:Oculomotor Nerve Diseases / Q000150:complications* / Q000473:pathology; D035583:Rare Diseases; D020521:Stroke / Q000150:complications / Q000473:pathology; D013577:Syndrome