Wernekink’s commissure syndrome

Case contributed by Dr Muthu Magesh

Presentation

Slurring of speech and altered sensorium for 2 days

Patient Data

Age: 40 years
Gender: Female

Midbrain shows diffusion restriction in the bilateral paramedian region consistent with acute infarction giving a typical heart appearance sign. Subtle T2 hyperintensities and T1 hypointensities seen. FLAIR doesn't show hyperintensities - possible subacute phase.

Case Discussion

Inferior paramedian mesencephalic arteries arise from the posterior cerebral artery, the superior cerebellar artery, and the tip of the basilar artery with variations in number, size, and origins and supply the anteromedial region of the caudal paramedian midbrain.

Thrombotic involvement of perforating vessels is most likely etiology for this patient. Pathology is likely due to medial and lateral paramedian branches supplying the anteromedial territory of the midbrain.

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Case information

rID: 78726
Published: 10th Jun 2020
Last edited: 11th Jun 2020
Inclusion in quiz mode: Included

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