Brain stem infarct

Lawrence Dubin, Robert M. Quencer

Research output: Contribution to journalArticlepeer-review


A 68-year-old man who was previously in good health suddenly lost consciousness while exercising. Upon awakening, he complained of numbness in his mouth, chin, the left side of the face, and the left arm. He then lapsed into a deep coma for 72 h. After regaining consciousness, he presented with several neurological deficits, including abduction of the left eye, distorted double vision, inability to elevate the head or eyes, lack of awareness of the extremities on the left side, and dysarthric and inarticulate speech. He recovered partially over the following 5 years but was still bothered by vertical and horizontal double vision and difficulty reading. On examination, he was found to have Horner's syndrome on the right side, classic macrosquare wave jerks, mild bilateral internuclear ophthalmoplegia, and skew deviation with hypertropia of the right eye when he looked to the right and hypertropia of the left eye when he looked to the left. Abnormal optokinetic responses were especially noted when the patient was asked to follow a target to the left or upward. A computed tomographic (CT) scan obtained 5 years later was read as normal and magnetic resonance (MR) was obtained. The MR abnormality was located in the dorsal pons. The T2 weighted axial images were suggestive of old hemorrhage. The appearance of a hematoma on MR will vary according to its age. While a subacute hematoma shows predominantly high signal intensity on T1 and T2 weighted images due to methemoglobin, older hematomas are conspicuous by the presence of the low intensity signal of hemosiderin. Depending on the type and amount of breakdown of blood products, there will be some or no residual methemoglobin in these chronic hematomas.

Original languageEnglish (US)
Pages (from-to)112-113
Number of pages2
JournalJournal of Clinical Neuro-Ophthalmology
Issue number2
StatePublished - Jun 1987

ASJC Scopus subject areas

  • Ophthalmology
  • Clinical Neurology


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