Presentation
Dysarthria and decreased level of consciousness.
Patient Data
Bilateral midbrain paramedian patchy rounded region of diffusion restriction (high DWI signal and low ADC signal) with corresponding high FLAIR signal.
Case Discussion
Wernekinck commissure syndrome is a rare neurological condition caused by a lesion in the dorsal tegmentum of the midbrain, specifically affecting the decussation of the superior cerebellar peduncles, also called the Wernekinck commissure. This syndrome leads to unique clinical and radiological findings. In this case, the cause was ischemic stroke.
More generally, possible etiologies of Wernekinck commisure syndrome include:
ischemic stroke: the most common cause (as in this case), involving the midbrain and posterior circulation
neoplasms: such as gliomas affecting the midbrain
multiple sclerosis: demyelinating plaques in the midbrain
vascular malformations: such as arteriovenous malformations (AVMs) or cavernous malformations
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