Weber's syndrome with recovery ct demonstration of an end-zone infarction in the territory of the mesencephalic artery

Abstract

SUMMARY -Weber's syndrome is one of the classically described brainstem syndromes. The mesencephalic artery and the syndromes resulting from occlusion of its branches have been attracting increasing interest in the past few years. We present here a case of Weber's syndrome emphasizing that (1) it is one of the major syndromes deriving from infarction in the territory of the mesencephalic artery; (2) that at least two clinical patterns of Weber's syndrome may be distinguished on the basis of the presence or lack of abnormal somnolence, mental confusion, and abulia; and (3) that each one of these patterns seems to be correlated with damage to distinct zones within the general territory of the mesencephalic artery. Síndrome de Weber com recuperação: demonstração tomográfica de infarto em zona terminal no território da artéria mesencefálica.RESUMO -A síndrome de Weber representa uma das síndromes clássicas do tronco cerebral. A artéria mesencefálica e as síndromes que resultam da oclusão dos seus ramos têm despertado interesse crescente nos últimos anos. Apresentamos um caso de síndrome de Weber, enfatizando que (1) é uma das principais síndromes decorrentes de infarto no território da artéria mesencefálica; (2) dois padrões clínicos, pelo menos, podem ser distinguidos da síndrome de Weber, com base na presença ou não de sonolência anormal, confusão mental e abulia; e (3) cada um desses padrões parece se correlacionar com lesão de zonas diferentes contidas no território geral da artéria mesencefálica.The association of third nerve ophthalmoplegia and contralateral hemiplegia was described by Weber in 1863 in a patient reported to have suffered from «severe rheumatic fever, since which time he frequently felt shortness of breath and palpitations of the heart» 45. At necropsy, «an oblong clot of blood» at the base of the brain, occupying the medial half of the cerebral peduncle close to the point of exit of the third nerve, was found. Nowadays, hemorrhagic infarction due to emboligenic valvular rheumatic heart disease would seem a reasonable explanation for the picture Weber delineated in his patient. Although he had also emphasized the presence of hemi-hyposthesia in his case, this has not traditionally been acknowledged as part of what later came to be referred to as «Weber's syndrome» (WS)1A In spite of the popularity it has always enjoyed among neurologists, relatively few case reports have been devoted to WS in specialized journals, perhaps because of the rarity with which isolated midbrain infarcts have been shown to occur: for example, Hinshaw et al. could not pick even one such case from their large series of 6,964 consecutive computerized tomographies (CTs) of the head 21. This might be one of the main reasons why the precise clinical limits and anatomic correlates of WS were never satisfactorily drawn, for in many cases on record additional signs and symptoms