Unilateral asterixis, thalamic astasia and vertical one and half syndrome in a unilateral posterior thalamo‑subthalamic paramedian infarct: An interesting case report

Subasree Ramakrishnan; Veera Rajkumar Narayanaswamy

doi:10.4103/0976-3147.112775

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Case Report

4 (

); 220-223

doi:

10.4103/0976-3147.112775

Unilateral asterixis, thalamic astasia and vertical one and half syndrome in a unilateral posterior thalamo‑subthalamic paramedian infarct: An interesting case report

Subasree Ramakrishnan^,, Veera Rajkumar Narayanaswamy

Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka

1 Department of Neurosciences, New Vikram Hospital, Madurai, Tamil Nadu, India

Dr. Subasree Ramakrishnan Department of Neurology, NIMHANS Bangalore, Karnataka India subasree.ramakrishnan@gmail.com

Journal of Neurosciences in Rural Practice

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Abstract

ABSTRACT

A 42-year-old young lady presented with acute onset of dizziness, drooping of left eye with binocular diplopia and inability to walk unassisted. She had past history of uncontrolled diabetes mellitus and hypertension. On examination, she had left fascicular type of third nerve palsy, vertical one and half syndrome (VOHS), left internuclear ophthalmoplegia and skew deviation with ipsilesional hypertropia. She also had thalamic astasia and right unilateral asterixis. Her MRI revealed T2 and Flair hyper intense signal changes with restricted diffusion in the left thalamus, subthalamus and left midbrain. MR Angiography was normal. Thalamic‑subthalamic paramedian territory infarct is relatively uncommon. It can present with oculomotor abnormalities including vertical one and half syndrome, skew deviation, thalamic astasia and asterixis. This case is reported for the rarity of the presenting clinical findings in unilateral thalamo‑mesencephalic infarcts.

Keywords

Thalamic astasia

thalamo‑mesencephalic infarct

unilateral asterixis

vertical one and a half syndrome

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Conflict of Interest

None declared

References

Bogousslavsky J, Regli F, Assal G, . The syndrome of unilateral tuberothalamic artery territory infarction. Stroke. 1986;17:434-41.
[Google Scholar]
Pierrot-Deseilligny C, . Nuclear, internuclear, and supranuclear ocular motor disorders. Handb Clin Neurol. 2011;102:319-31.
[Google Scholar]
Alemdar M, Kamaci S, Budak F, . Unilateral midbrain infarction causing upward and downward gaze palsy. J Neuro Ophthalmol. 2006;26:173-6.
[Google Scholar]
Bogousslavsky J, . Oculomotor syndromes resulting from mesencephalic lesions in man. Rev Neurol. 1989;145:546-59.
[Google Scholar]
Suzuki K, Odaka M, Tatsumoto M, Miyamaoto T, Takamatsu K, Hirata K, . Case of unilateral thalamo-mesencephalic infarction with enlargement to bilateral vertical gaze palsy due to vertical one-and-a-half syndrome. Brain Nerve. 2008;60:92-6.
[Google Scholar]
Bogousslavsky J, Regli F, . Up gaze palsy and monocular paresis of downward gaze from ipsilateral thalamo-mesencephalic infarction: A vertical "one-and-a-half" syndrome. J Neurol. 1984;231:43-5.
[Google Scholar]
Deleu D, Imam Y. Z., Mesraoua B, Salem K. Y., . Vertical one-and-a-half syndrome with contralesional pseudo-abducens palsy in a patient with thalamo mesencephalic stroke. J Neurol Sci. 2012;312:180-3.
[Google Scholar]
Wall M, Slamovits T. L., Weisberg L. A., Trufant S. A., . Vertical gaze ophthalmoplegia from infarction in the area of the posterior thalamo-subthalamic paramedian artery. Stroke. 1986;17:546-55.
[Google Scholar]
Weidauer S, Nichtweiss M, Zanella F. E., Lanfermann H, . Assessment of paramedian thalamic infarcts: MR imaging, clinical features and prognosis. Eur Radiol. 2004;14:1615-26.
[Google Scholar]
Hommel M, Bogousslavsky J, . The spectrum of vertical gaze palsy following unilateral brainstem stroke. Neurology. 1991;41:1229-34.
[Google Scholar]
Masdeu J. C., Gorelick P. B., . Thalamic astasia: Inability to stand after unilateral thalamic lesions. Ann Neurol. 1988;23:596-603.
[Google Scholar]
Solomon D. H., Barohn R. J., Bazan C, Grissom J, . The thalamic ataxia syndrome. Neurology. 1994;44:810.
[Google Scholar]
Young R. R., Shahani B. T., . Asterixis: One type of negative myoclonus. Adv Neurol. 1986;43:137-56.
[Google Scholar]
Stell R, Davis S, Carroll W. M., . Unilateral asterixis due to a lesion of the ventrolateral thalamus. J Neurol Neurosurg Psychiatry. 1994;57:116-8.
[Google Scholar]
Wee A. S., . Unilateral asterixis: Case report and comments. Eur Neurol. 1986;25:208-11.
[Google Scholar]
Klos K. J., Wijdicks E. F., . Unilateral asterixis after thalamic hemorrhage. Neurology. 2006;66:E11.
[Google Scholar]
Gokula R. M., Khasnis A, . Asterixis. J Postgraduate Med. 2003;49:272-5.
[Google Scholar]

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[1] Bogousslavsky J, Regli F, Assal G, . The syndrome of unilateral tuberothalamic artery territory infarction. Stroke. 1986;17:434-41.
[Google Scholar]

[2] Pierrot-Deseilligny C, . Nuclear, internuclear, and supranuclear ocular motor disorders. Handb Clin Neurol. 2011;102:319-31.
[Google Scholar]

[3] Alemdar M, Kamaci S, Budak F, . Unilateral midbrain infarction causing upward and downward gaze palsy. J Neuro Ophthalmol. 2006;26:173-6.
[Google Scholar]

[4] Bogousslavsky J, . Oculomotor syndromes resulting from mesencephalic lesions in man. Rev Neurol. 1989;145:546-59.
[Google Scholar]

[5] Suzuki K, Odaka M, Tatsumoto M, Miyamaoto T, Takamatsu K, Hirata K, . Case of unilateral thalamo-mesencephalic infarction with enlargement to bilateral vertical gaze palsy due to vertical one-and-a-half syndrome. Brain Nerve. 2008;60:92-6.
[Google Scholar]

[6] Bogousslavsky J, Regli F, . Up gaze palsy and monocular paresis of downward gaze from ipsilateral thalamo-mesencephalic infarction: A vertical "one-and-a-half" syndrome. J Neurol. 1984;231:43-5.
[Google Scholar]

[7] Deleu D, Imam Y. Z., Mesraoua B, Salem K. Y., . Vertical one-and-a-half syndrome with contralesional pseudo-abducens palsy in a patient with thalamo mesencephalic stroke. J Neurol Sci. 2012;312:180-3.
[Google Scholar]

[8] Wall M, Slamovits T. L., Weisberg L. A., Trufant S. A., . Vertical gaze ophthalmoplegia from infarction in the area of the posterior thalamo-subthalamic paramedian artery. Stroke. 1986;17:546-55.
[Google Scholar]

[9] Weidauer S, Nichtweiss M, Zanella F. E., Lanfermann H, . Assessment of paramedian thalamic infarcts: MR imaging, clinical features and prognosis. Eur Radiol. 2004;14:1615-26.
[Google Scholar]

[10] Hommel M, Bogousslavsky J, . The spectrum of vertical gaze palsy following unilateral brainstem stroke. Neurology. 1991;41:1229-34.
[Google Scholar]

[11] Masdeu J. C., Gorelick P. B., . Thalamic astasia: Inability to stand after unilateral thalamic lesions. Ann Neurol. 1988;23:596-603.
[Google Scholar]

[12] Solomon D. H., Barohn R. J., Bazan C, Grissom J, . The thalamic ataxia syndrome. Neurology. 1994;44:810.
[Google Scholar]

[13] Young R. R., Shahani B. T., . Asterixis: One type of negative myoclonus. Adv Neurol. 1986;43:137-56.
[Google Scholar]

[14] Stell R, Davis S, Carroll W. M., . Unilateral asterixis due to a lesion of the ventrolateral thalamus. J Neurol Neurosurg Psychiatry. 1994;57:116-8.
[Google Scholar]

[15] Wee A. S., . Unilateral asterixis: Case report and comments. Eur Neurol. 1986;25:208-11.
[Google Scholar]

[16] Klos K. J., Wijdicks E. F., . Unilateral asterixis after thalamic hemorrhage. Neurology. 2006;66:E11.
[Google Scholar]

[17] Gokula R. M., Khasnis A, . Asterixis. J Postgraduate Med. 2003;49:272-5.
[Google Scholar]

Unilateral asterixis, thalamic astasia and vertical one and half syndrome in a unilateral posterior thalamo‑subthalamic paramedian infarct: An interesting case report

Abstract

ABSTRACT

Keywords

Thalamic astasia

thalamo‑mesencephalic infarct

unilateral asterixis

vertical one and a half syndrome

Conflict of Interest

References

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