Unilateral right paramedian infarction of thalamus and midbrain

Case contributed by Bahman Rasuli
Diagnosis almost certain

Presentation

Impaired eye movements and left-sided motor hemineglect.

Patient Data

Age: 65 years
Gender: Male

Abnormal signal area (high on T2/FLAIR) diffusion restriction is present it the right thalamus dorsomedial nucleus and paramedian midbrain related to ischemic stroke events.

High signal foci in T2 and FLAIR sequences in the subcortical and periventricular white matter of both cerebral hemispheres depicts microvascular ischemic events.

Case Discussion

The paramedian infarct is rarely found as an isolated lesion and always seen bilaterally when there is only one arterial pedicle. 

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