A 67-year-old man is brought to the Emergency Department by his wife. She explains that he fell suddenly, could not get out of his bed, and complained of feeling sick. The examination revealed a left-sided weakness of the upper and lower extremities, a lack of most movement of the right eye, and a dilated pupil on the right. MRI shows an infarcted area in the brainstem. Which of the following descriptive phrases best describes the constellation of signs and symptoms seen in this man?
- Superior alternating hemiplegia
- Alternating hemianesthesia
- Brown-Séquard syndrome
- Inferior alternating hemiplegia
- Middle alternating hemiplegia
The loss of most eye movement on one side (oculomotor nerve root involvement) coupled with a paralysis of the extremities on the contralateral side is a superior alternating hemiplegia (this is also known as Weber syndrome): “superior” because it is the most rostral of three; “alternating” because it is a cranial nerve on one side and the extremities on the other; and “hemiplegia” because half of the body below the head is involved.
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