Wernekink’s commissure syndrome
Slurring of speech and altered sensorium for 2 days
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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.
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.