Diagnosis and treatment of midbrain infarction presenting with ophthalmoplegia as the initial manifestation:a report of two cases
FAN Yutian
WU Wei
GONG Weigang
CAO Lili
ZHANG Lijuan
Abstract：Objective To investigate the clinical characteristics,imaging features,and key diagnostic and thera-peutic considerations of midbrain infarction presenting with ophthalmoplegia as the initial manifestation,thereby enhanc-ing clinicians'ability to recognise this uncommon presentation.Methods A retrospective analysis was conducted on the clinical data of two patients with acute mesencephalic lacunar infarction presenting with ophthalmoplegia.The data includ-ed medical history,neurological examination,imaging studies,diagnostic and therapeutic processes,and follow-up out-comes,supplemented by relevant literature review.Results Both patients presented with ophthalmoplegia symptoms such as diplopia in the early stages,without significant additional neurological signs.Case 1 presented with typical anteri-or nucleus-interstitial ophthalmoplegia;imaging revealed acute lacunar infarction in the paramedian midbrain region,sug-gesting involvement of the left medial longitudinal fasciculus.Case 2 exhibited hypoglossal oculomotor palsy;imaging dem-onstrated acute punctate infarction adjacent to the midbrain aqueduct,indicating involvement of structures related to the superior branch of the oculomotor nerve.Both patients had risk factors for cerebrovascular events,including diabetes melli-tus.Diffusion-weighted imaging(DWI)on cranial magnetic resonance imaging(MRI)demonstrated lesions in the early phase,with some sequences showing atypical patterns.Following standardised antiplatelet therapy,lipid-lowering treat-ment,and risk factor management,follow-up revealed complete resolution of ocular muscle paralysis symptoms in both cas-es,with favourable outcomes.Conclusions Interstitial and subnuclear ophthalmoplegia represent uncommon initial pre-sentations of midbrain infarction.Early integration of neurological examination with cranial MRI and DWI facilitates defini-tive diagnosis and guides standardised management,thereby improving patient outcomes.
Keywords：midbrain infarctionophthalmoplegiainterstitial ophthalmoplegiaoculomotor nerve palsy
Publication Date：2026-02-25
Online Publishing Date：2026-03-19(First online date of this platform, not the publication date of the document)
Pages：5( 70-74 )