Essay --

Wernekink commissure syndrome secondary to ischemic stroke: severe dysarthria is one of the main characteristics of this syndrome Introduction Pure midbrain infarctions are relatively rare. Several midbrain syndromes such as Weber’s, Claude’s and Benedikt’s syndrome had been described extensively before. Because of its rarity, clinicians do not frequently confront Wernekink commissure syndrome, but it is one of the midbrain syndromes. Wernekink commissure involves the decussation of dentatorubrothalamic pathway, which provides cerebrocerebellum connections through superior cerebellar peduncle in midbrain. Its main characteristics are bilateral cerebellar dysfunction, occasional oculomotor signs including internuclear ophtalmoplegia or palatal tremor [1-3]. We report a case of a patient with Wernekink commissure syndrome due to focal infarction in the caudal paramedian midbrain presenting with anarthria and bilateral cerebellar ataxia. Case Report A 62-year-old male current smoker was admitted to stroke unit in our hospital because of sudden onset dizziness, impaired speech and gait disturbance. He could barely walk without assistance. On admission day, his vital signs were normal except a blood pressure of 162/94 mmHg. He was alert and not dysphasic but his pronunciation was markedly slurred. He could not pronounce a single syllable. The extraocular movements were full, but he showed saccadic pursuit in all directions. Upbeating nystagmus appeared when he gazed upward. All limb extremities showed Medical Research Council (MRC) Grade 5 motor power and sensory examinations did not reveal any abnormality. Motor incoordinations were detected with finger-to-nose, heel-to-shin and rapid alternating movement test on both sides, the le... ...in the adult]. Revue neurologique 98 (6):435-477 3. Liu H, Qiao L, He Z (2012) Wernekink commissure syndrome: a rare midbrain syndrome. Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology 33 (6):1419-1421. doi:10.1007/s10072-012-0966-4 4. Mossuto-Agatiello L (2006) Caudal paramedian midbrain syndrome. Neurology 66 (11):1668-1671. doi:10.1212/01.wnl.0000218180.03127.11 5. Zhu Y, Liu HN, Zhang CD (2010) Wernekinck commissure syndrome is a pure midbrain infarction. Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia 17 (8):1091-1092. doi:10.1016/j.jocn.2009.11.032 Figure Legend Fig.1. Diffusion-weighted magnetic resonance image (MRI) showed diffusion restriction located in the paramedian midbrain (arrowheads).