Acute midbrain infarction

Case contributed by Dr Ian Bickle

Presentation

Hypertensive diabetic middle aged male with acute onset right ptosis, left facial palsy and left pronator drift. Brainstem infarct?

Patient Data

Age: 50 years
Gender: Male
MRI

DWI/ADC map demonstrates 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 ischemic change.

No aneurysm or flow limiting stenosis.

Case Discussion

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.

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