Acute midbrain infarction
Hypertensive diabetic middle aged male with acute onset right ptosis, left facial palsy and left pronator drift. Brainstem infarct?
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MRI BRAIN and MRA
DWI/ADC map avid diffusion restriction in the right side of the mesencephalon, chiefly involving the tegmentum.
Left side of mesencephalon normal.
Small volume established periventricular small vessel ischaemic change.
No aneurysm or flow limiting stenosis.
The midbrain (mesencephalon) is the most rostral part of the brainstem and sits above the pons and is adjoined rostrally to the thalamus. The largest component is the tegmentum, which contains the brainstem nuclei.
It is one of the less common sites for an isolated infarct.
This is a decent example of an acute right midbrain infarction.