[Nuclear syndrome of the oculomotor nerve caused by a mesencephalic infarction confirmed by MRI]. / Síndrome "nuclear" del motor ocular común por infarto mesencefálico confirmado con RM.

The nuclear syndrome of the third nerve was first described in 1981. It has the very characteristic disturbance of an ophthalmoplegia with complete ipsilateral third nerve palsy associated with paresis of elevation in contralateral eye. This particularly presentation is due to the innervation of the superior rectus which comes mainly from the contralateral oculomotor nucleus. As associated signs were described contralateral cerebellar and or pyramidal syndromes, uni or bilateral parasympathetic disfunction and sometimes gaze disorders. The etiology es usually a vascular damage (ischemic most frequently) located in mesencephalon. We report on a case of a 60 years old man who developed acute nuclear ophthalmoplegia of the third right nerve accompanied with cerebellar and pyramidal syndrome and focal asterixis in left extremities. MRI showed an ischemic lesion in right paramedial mesencephalic territory with extension to the ipsilateral thalamic region. Pyramidal and cerebellar syndromes and asterixis disappeared in a few weeks, while ophthalmoplegia remained unchanged. Semiologic characteristics and anatomic basis of the nuclear oculomotor syndrome which allow to make the differential diagnosis between this syndrome and intra-axial fascicular disturbances of the third nerve (Weber, Claude and Benedikt syndromes) are discuss.

[Ischemic ictus in a young woman with fibromuscular dysplasia of the basilar artery]. / Ictus isquémico en mujer joven por displasia fibromuscular de la arteria basilar.

Fibromuscular dysplasia (FMD) is a vasculopathy of unknown etiology generally presented in young women and preferentially found in the renal arteries. The second site of frequency of appearance corresponds to the cervical-cephalic arteries with cases of the intracranial vessels being exceptional. We recently had the opportunity to study a female patient of 29 years of age admitted following an acute progressive cerebrovascular event. Cranial computerized tomography (CT) demonstrated multiple ischemic lesions bilaterally affecting the basilar-vertebral territory. Angiographic study established the diagnosis of FMD upon observing "pearl-like" lesions located in the distal part of the basilar artery. Anticoagulant treatment was initiated and the patient evolved satisfactorily although some neurologic deficits persisted. The authors insist on the need to consider FMD as a cause of ictus in young, specially female, patients.