A Case Report of Isolated Bilateral Cerebral Peduncular Infarction

Abstract

Isolated bilateral cerebral peduncular infarctions (BCPI) presenting as acute pseudobulbar palsy are rarely reported and, to the best of our knowledge, most of the previous reports of BCPI were related to locked-in syndrome and disturbance of consciousness. Herein, we described a case of a 55-year-old man who presented with acute pseudobulbar palsy and mild tetraparesis, but preserved eye movements, with no consciousness disturbance. DWI revealed an acute infarction involving the central portion of the cerebral peduncle with a characteristic "traditional Chinese eight character" sign. The relationship between the infarcted range in the cerebral peduncle and the clinical manifestation was discussed in our report.

Figure 1

(a) Diffusion-weighted image showing high signal intensity in bilateral cerebral peduncles, with corresponding hypointensity on apparent diffusion coefficient map (b). T1-weighted (c) magnetic resonance imaging showing low intensity in bilateral cerebral peduncles with sparing of the medial and most of the lateral portion with low signal intensity. The entire basilar and distal vertebral arteries (white arrow) are not shown on the magnetic resonance angiography (MRA) (d).

Figure 2

Schematic diagram of the involved areas of cerebral peduncular infarction showing the present case on the right side (yellow), the case from Dehaene and Dom's report (red + blue), and the case from Tarek Zakaria's report (blue) on the left side.