As the nuclei and fascicles are spread across a relatively wide area, mid-brain lesions can lead to partial 3rd nerve lesions. Fascicles from the nuclei run forward and laterally through the red nuclei and converge at the inter-peduncular fossa before emerging from the mid-brain. It consists of: (a) the Edinger-Westphal nucleus located in the upper mid-brain supplying fibers to the pupils and (b) the motor nucleus located in the lower mid-brain supplying the extra-ocular muscles, except the lateral rectus and the superior oblique. The 3rd nerve nuclei are located in the mid-brain and are approximately 10 mm in length from the rostral to caudal extent. Subsequently, cases have been reported wherein mid-brain lesions can produce a 3rd nerve lesion sparing the pupils, be it due to infarct, tumor or bleed. The clinical findings of Weber's syndrome include an ipsilateral 3rd nerve palsy and a contralateral limb weakness due to a lesion in the mid-brain (crus cerebri). He described a 52-year-old man who presented with right limb weakness and left oculomotor palsy (involving the pupils) caused by a hemorrhage in the left cerebral peduncle. Weber's syndrome was described in 1863 by the German physician Hermann Weber. The diagnosis of Weber's syndrome without pupillary involvement was made on the basis of a crossed hemiplegia: left 3rd nerve palsy and right hemiparesis.2 The MRI showed numerous small T2W signal hyperintensities within the cerebral white matter and the lower mid-brain, consistent with infarcts. She subsequently had a Magnetic Resonance Imaging (MRI) of the brain which established the diagnosis. Two weeks later, she had no more diplopia and was discharged with no neurological sequel. Over the next week her hemiparesis resolved completely and her diplopia was getting better. A Computerized Tomograph (CT) scan of the brain showed possible lacunar infarcts in the basal ganglia. On presentation, she had a right hemiparesis and a left 3rd nerve palsy (drooping of eyelid/ lateral deviation of the eye/ diplopia on looking to the right) without involvement of the pupils. Her medications included gliclazide, metformin, insulin, thyroxine, genotropin, desmopressin and aspirin. This operation was not complicated by any cranial nerve palsy. She underwent pituitary surgery (hypophysectomy) in 1977. She had been a diabetic and hypertensive for the past 20 years. However, this syndrome may be reversible as described in this report.Ī 68-year-old lady noticed weakness of the right arm and leg and diplopia on waking in the morning. If the 3rd nerve palsy is associated with contralateral hemiplegia, the condition is described as Weber's syndrome. Available from: Ī complete oculomotor (3rd) nerve lesion results in ipsilateral ptosis, pupillary dilatation, loss of pupillary and accommodation reflexes and lateral deviation of the eye. A patient with reversible pupil-sparing Weber’s syndrome How to cite this URL: Umasankar U, Huwez F U. How to cite this article: Umasankar U, Huwez F U. In addition, this case report documents that a pupil-sparing Weber’s syndrome could be reversible. The article also describes the neuroanatomy of the oculomotor nerve and how its partial lesions lead to sparing of the pupil. An ischemic lesion of the lower mid-brain was demonstrated on the MRI scan of the brain, which corresponds to the motor nucleus of the oculomotor nerve. The patient subsequently made a good recovery. She had left oculomotor nerve palsy with normal pupil and right hemiparesis. This is a case report of a lady who presented with pupil-sparing Weber’s syndrome. Stroke Unit (Lister Ward), Basildon University Hospital, Basildon, Essex SS16 5NL
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