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Case Reports
. 2019 Nov;98(44):e17665.
doi: 10.1097/MD.0000000000017665.

Rare presentation of an isolated bilateral cerebral peduncular infarction: A case report and review of the literature

Xiaoxue Fu  1 , Hongyu Li  1 , Xiaoquan Tian  1 , Wei Wang  2 , Hong Liu  1
Affiliations
Case Reports

Rare presentation of an isolated bilateral cerebral peduncular infarction: A case report and review of the literature

Xiaoxue Fu et al. Medicine (Baltimore). 2019 Nov.

Abstract

Rationale: Due to the rarity of bilateral cerebral peduncular infarction (BCPI), its symptoms and prognosis are not clear. It is necessary to collect cases of pure cerebral peduncular infarction, explore the etiology and anatomy of midbrain infarction in depth, and develop meaningful tools for explaining clinical symptoms and predicting prognosis of patients.

Patient concerns: We here provide a case of isolated BCPI with uncommon symptoms of ataxia, dysarthria, sensory disturbance, normal muscular strength, and full eye movements.

Diagnoses: Diffusion weighted images and apparent diffusion coefficient map of our patient revealed acute and isolated bilateral peduncle cerebrum infarction.

Interventions: Drugs that could improve circulation and antiplatelet were used in therapy.

Outcomes: The infarct size was enlarged and new infarction was identified in the splenium of the corpus callosum and pons. The patient developed progressed disorder of consciousness and died at the eleventh day.

Lessons: We inferred that the symptoms of ataxia, dysarthria, sensory disturbance, and mild paresis of the extremities could be prominent features of patients with pure cerebral peduncular infarction. We hypothesize that pure BCPI is also related to severe basilar artery stenosis or occlusion and there is no collateral circulation from PCA. This may explain the corresponding distribution of cerebral peduncular infarction and its poor prognosis. For these reasons, exploring etiology and anatomy of midbrain infarction in depth would have clinical value for predicting symptoms and prognosis.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
(A). Diffusion weighted imaging (DWI) performed upon admission showed a hyperintense bilateral peduncle cerebrum infarction; (B). With slight hypointensity in the apparent diffusion coefficient (ADC) map at the same position.
Figure 2
Figure 2
Magnetic resonance angiography (MRA) showed the vertebrobasilar artery and right posterior cerebral artery (PCA) occlusion, left arteriae cerebral artery (ACA) stenosis, and left fetal posterior cerebral artery (fPCA).
Figure 3
Figure 3
Re-examination of DWI (A) and ADC (B) on the eighth day of hospitalization.
Figure 4
Figure 4
Functional areas of the cerebral peduncule.
See this image and copyright information in PMC

References

    1. Kim JS, Kim J. Pure midbrain infarction: clinical, radiologic, and pathophysiologic findings. Neurology 2005;64:1227–32. - PubMed
    1. Chen W, Yi T, Chen Y, et al. Assessment of bilateral cerebral peduncular infarction: magnetic resonance imaging, clinical features, and prognosis. J Neurol Sci 2015;357:131–5. - PubMed
    1. Bogousslavsky J, Maeder P, Regli F. Pure midbrain infarction: clinical syndromes, MRI, and etiologic patterns. Neurology 1994;44:2032–40. - PubMed
    1. Asakawa Y, Suzuki K, Takekawa H, et al. The ‘Mickey Mouse ears’ sign: a bilateral cerebral peduncular infarction. Eur J Neurol 2013;20:e37–9. - PubMed
    1. Zhou C, He Y, Tian X, et al. A case report of isolated bilateral cerebral peduncular infarction. Case Rep Neurol Med 2017;2017:9845917. - PMC - PubMed

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