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A Case of Dorsal Midbrain Syndrome in 2nd Trimester of Pregnancy


Advances in Ophthalmology & Visual System
Salah AlRashidi1*, Ahmed M Wanasand Mohamed F Oraby3
Head of the ophthalmology department, Farwaniya Hospital, Kuwait

Abstract

The incidence rates for ischemic strokes associated with pregnancy or puerperium vary in the literature from 5 to 210 per 100000 deliveries [1-4]. Wiebers [5] estimated that pregnancy increases the likelihood of cerebral infarction to about 13 times the rate expected outside of pregnancy; most of them were diagnosed as having cerebral ischemia and thought to be due to cerebral venous thrombosis. Cross et al. [6] identified 31 cases of ischemic carotid territory stroke in pregnant women in Glasgow during the 10-year period of 1956 through 1967. The authors suggested that the frequency of cerebral infarction was approximately 5 cases per 100000 deliveries. Syndrome consists of impaired vertical gaze, retraction nystagmus, pupillary abnormalities, convergence nystagmus, convergence spasm, vertical nystagmus and extra-ocular palsies. The first three signs are most commonly present [12]. We present a case of a pregnant patient presented to us within minutes of acute onset of nystagmus and vertical binocular diplopia following syncope for a few seconds. The initial examination at scene of the incident revealed signs of dorsal midbrain syndrome. Although MRI and MRV were normal, we insisted on a subsequent MRI with contrast to be done which had revealed the stroke site being in the midbrain region. 

Keywords

Dorsal midbrain syndrome, Trimester, Pregnancy, Puerperium, Thrombosis, MRI, Midbrain region, MRV, CTA, Neuroimaging

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