title: Unilateral asterixis, thalamic astasia and vertical one and half syndrome in a unilateral posterior thalamo-subthalamic paramedian infarct: An interesting case report.
abstract: A 42-year-old young lady presented with acute onset of dizziness, drooping of left eye with binocular diplopia and inability to walk unassisted. She had past history of uncontrolled diabetes mellitus and hypertension. On examination, she had left fascicular type of third nerve palsy, vertical one and half syndrome (VOHS), left internuclear ophthalmoplegia and skew deviation with ipsilesional hypertropia. She also had thalamic astasia and right unilateral asterixis. Her MRI revealed T2 and Flair hyper intense signal changes with restricted diffusion in the left thalamus, subthalamus and left midbrain. MR Angiography was normal. Thalamic-subthalamic paramedian territory infarct is relatively uncommon. It can present with oculomotor abnormalities including vertical one and half syndrome, skew deviation, thalamic astasia and asterixis. This case is reported for the rarity of the presenting clinical findings in unilateral thalamo-mesencephalic infarcts.
authors.affiliation: Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India.
authors.forename: Subasree
authors.initials: S
authors.lastname: Ramakrishnan
authors.forename: Veera Rajkumar
authors.initials: VR
authors.lastname: Narayanaswamy
keywords: Thalamic astasia; thalamo-mesencephalic infarct; unilateral asterixis; vertical one and a half syndrome
references.citation: Neurology. 1991 Aug;41(8):1229-34
references.pmid: 1866011
references.citation: J Postgrad Med. 2003 Jul-Sep;49(3):272-5
references.pmid: 14597795
references.citation: J Neurol Sci. 2012 Jan 15;312(1-2):180-3
references.pmid: 21917272
references.citation: Adv Neurol. 1986;43:137-56
references.pmid: 3946109
references.citation: J Neuroophthalmol. 2006 Sep;26(3):173-6
references.pmid: 16966933
references.citation: Handb Clin Neurol. 2011;102:319-31
references.pmid: 21601072
references.citation: Neurology. 2006 Jan 24;66(2):E11
references.pmid: 16434643
references.citation: Stroke. 1986 May-Jun;17(3):434-41
references.pmid: 2424153
references.citation: Eur Neurol. 1986;25(3):208-11
references.pmid: 3699071
references.citation: J Neurol. 1984;231(1):43-5
references.pmid: 6716110
references.citation: Rev Neurol (Paris). 1989;145(8-9):546-59
references.pmid: 2682933
references.citation: J Neurol Neurosurg Psychiatry. 1994 Jan;57(1):116-8
references.pmid: 8301291
references.citation: Stroke. 1986 May-Jun;17(3):546-55
references.pmid: 3715958
references.citation: Eur Radiol. 2004 Sep;14(9):1615-26
references.pmid: 15106015
references.citation: Ann Neurol. 1988 Jun;23(6):596-603
references.pmid: 2841901
references.citation: Brain Nerve. 2008 Jan;60(1):92-6
references.pmid: 18232338