A Rare Midbrain Syndrome with Bilateral Cerebellar Ataxia and Isolated Superior Rectus Palsy: Wernekinck Commissure Syndrome

Wernekinck commissure syndrome is a rare midbrain syndrome, usually resulting in selective destruction of the decussation of the superior cerebellar peduncle. This syndrome can present with symptoms such as bilateral cerebellar ataxia, ophthalmoplegia, and palatal tremor. Here, we report a 61-year-old female with acute onset of bilateral cerebellar ataxia and isolated superior rectus palsy diagnosed on Wernekinck commissure syndrome confirmed by magnetic resonance imaging.

Homonymous Central Scotomatous Visual Field Defect in a Patient with Lateral Geniculate Nucleus Infarction

Incongruous visual field defects, such as sectoranopia, can result from lateral geniculate nucleus infarction. We present a rare case of right lateral geniculate nucleus infarction that manifests as a left inferior homonymous paracentral scotoma. According to the retinotopic organization of the visual tract, central vision from the macula is delivered to the occipital pole via the posterior portion of the lateral geniculate nucleus. Consequently, not only can occipital pole infarction lead to central visual loss, but partial lateral geniculate nucleus infarction can also produce similar manifestations of central visual loss.

A case of mild CADASIL patient with a novel heterozygous NOTCH3 variant

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a single-gene disease caused by mutations in the neurogenic locus notch homolog protein 3 (NOTCH3) gene. The spectrum of clinical manifestations is broad, ranging from asymptomatic to typical ischemic stroke, and mainly depends on the location of the mutations. We describe the case of a 76-year-old female without apparent neurological deficits. However, brain magnetic resonance imaging revealed confluent lesions in the white matter. Direct sequencing of the NOTCH3 gene revealed a novel pathogenic mutation, c.811T>A, which results in a mild phenotype. Therefore, this report will expand the current knowledge in regards to the mutations that can cause CADASIL.

Acute Ischemic Stroke Caused by Detachment of Cardiac Papillary Fibroelastomas

Cardiac papillary fibroelastomas are associated with a high risk of systemic embolization in spite of benign nature. We report a case of 85-year-old patient with left supraclinoid internal carotid artery occlusion who treated with aspiration thrombectomy. Despite of the absence of residual mass on echocardiography, we could analyze pathologic specimens using retrieved embolus and confirmed cardiac papillary fibroelastoma as a rare cause of stroke.