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Chenguang Zhou [1] and Yuanhong He [1] and Xiaorui Tian [1] and Zhiwen Chao [1] and Yinghui Zhu [1] and Du Cheng [1] and Kui Li [1]
Academic Editor: Peter Berlit
Department of Neurology, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, China, ztzy.com
Received May 27, 2017; Accepted Jun 21, 2017
This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
1. Introduction
Bilateral cerebral peduncular infarctions (BCPI) are an extremely rare neurological disorder, occurring in only 0.26% of patients with acute ischemic stroke [1]. The anatomic etiology is presumed to be the occlusion or stenosis of the large vertebrobasilar artery. Several cases of BCPI have been reported earlier to be associated with locked-in syndrome and disturbance of consciousness [2–6]. However, cerebral peduncle lesions in such cases were accompanied with infarctions in other regions such as pons, cerebellum, and other posterior cerebral artery (PCA) territories. To the best of our knowledge, isolated bilateral BCPI demonstrated by MRI is rare and has hitherto been described in only 1 patient before this article [6]. Herein, we reported a patient presenting with acute pseudobulbar palsy, mild tetraparesis, and intact eye movements, which resulted from isolated and symmetric BCPI mainly involving the central portion of the cerebral peduncle.
2. Case Report
A 55-year-old man with known longstanding hypertension and diabetes mellitus type 2 presented with acute onset of dizziness, slurred speech, and unsteady gait. On admission, his blood pressure was 178/100 mmHg and heart rate was 92 beats/min. He was dispirited but oriented. Additionally, he did not take the initiative to speak but could answer simple questions in a whisper with a few words. Neurological examination revealed severe dysphagia, dysarthria, mild tetraplegia (Medical Research Council Grade 4-5), and ataxia of the trunk and all four limbs. Pupillary reflexes and extraocular movements (both vertical and horizontal) were intact. Bilateral Babinski signs were positive. Meanwhile, he also showed spasmodic crying and laughing on examination. Magnetic resonance imaging (MRI) of the brain performed 36 hours after the onset of symptoms revealed...