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Medical condition
Weber's syndrome
Other names
Midbrain stroke syndrome
Superior alternating hemiplegia
Weber's syndrome, also known as midbrain stroke syndrome or superior alternating hemiplegia, is a form of stroke that affects the medial portion of the midbrain. It involves oculomotor fascicles in the interpeduncular cisterns and cerebral peduncle so it characterizes the presence of an ipsilateral lower motor neuron type oculomotor nerve palsy and contralateral hemiparesis or hemiplegia.
Cause
It is mainly caused by a midbraininfarction as a result of occlusion of a branch of posterior cerebral artery most commonly or the paramedian branches of basilar bifurcation perforating arteries.
This lesion is usually unilateral and affects several structures in the midbrain including:
contralateralparkinsonism because its dopaminergic projections to the basal ganglia innervate the ipsilateral hemisphere motor field, leading to a movement disorder of the contralateral body.
contralateral hemiparesis (if lateral corticospinal tract is only affected) & contralateral hemiplegia (if both lateral & anterior corticospinal tracts are affected) and typical upper motor neuron findings. It is contralateral because it occurs before the decussation in the medulla.
ipsilateral lower motor neuron type oculomotor nerve palsy with a drooping eyelid (partial ptosis) and fixed wide pupil pointed down and out (mydriasis). This leads to diplopia.
Clinical findings mainly eyeball is down and out ipsilateral lateral squint.
Ptosis present as the levator palpebrae superioris nerve supply is disrupted.
Pupil dilated and fixed.
Contralateral hemiplegia
CT scan or MRI might help in delineating the cause or the vessel or region of brain involved in stroke.
Management
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