Scanning Dysarthria Secondary to Spontaneous Midbrain Hemorrhage

The patient was an 83-year-old woman admitted to our hospital for sudden onset of transient dizziness, limitation on articulation of speech and mild gait instability. The only relevant antecedent in this patient was type II diabetes mellitus diagnosed 5 years earlier. This vascular risk factor was optimally controlled with habitual doses of 2 oral antidiabetic drugs. The neurological examination performed on admission showed scanning dysarthria, vertical binocular diplopia in the upward gaze due to a limitation on supraversion of the left eye and mild gait instability with left lateropulsion. No abnormalities of eyelids, diameter of pupils Dear Sir, Acute vascular lesions limited to the midbrain are relatively uncommon and are usually ischemic. Isolated and spontaneous mesencephalic hemorrhages are rare because they are usually a secondary phenomenon resulting either from upward extension of a hemorrhage into the pons or cerebellum, or a downward extension of thalamic or putamen bleeding. The most frequent etiologies of isolated bleedings are arteriovenous malformations and blood dyscrasias, whereas hypertension is an infrequent etiology. Approximately one third of these bleedings remain of unknown cause [1] . Since the microscopic anatomy of the midbrain is extremely complex, the clinical manifestations are broad and include combinations of ataxia and vertigo, different disorders of ocular motility, parkinsonian signs and even hydrocephalus due to aqueduct obstruction. The prognosis as reported in the first descriptions of mesencephalic hemorrhages was poor. However, the increasing use of imaging techniques in recent years has allowed reporting of short series of patients showing more benign bleedings with relatively good clinical outcome. We report a patient with an isolated midbrain hemorrhage who presented brief clinical manifestations not previously described in the literature. The anatomical correlation is discussed and previous reports of mesencephalic hemorrhages are reviewed. Received: July 11, 2007 Accepted: September 18, 2007 Published online: June 14, 2008