Weber's syndrome

Weber's syndrome, also known as superior alternating hemiplegia, is a form of stroke characterized by the presence of an ipsilateral oculomotor nerve palsy and contralateral hemiparesis or hemiplegia. It is caused by midbrain infarction as a result of occlusion of the paramedian branches of the posterior cerebral artery or of basilar bifurcation perforating arteries.

Cause

This lesion is usually unilateral and affects several structures in the midbrain including:

Structure damaged	Effect
substantia nigra	contralateral parkinsonism because its dopaminergic projections to the basal ganglia innervate the ipsilateral hemisphere motor field, leading to a movement disorder of the contralateral body.
corticospinal fibers	contralateral hemiparesis and typical upper motor neuron findings. It is contralateral because it occurs before the decussation in the medulla.
corticobulbar tract	difficulty with contralateral lower facial muscles and hypoglossal nerve functions
oculomotor nerve fibers	ipsilateral oculomotor nerve palsy with a drooping eyelid and fixed wide pupil pointed down and out. This leads to diplopia

Human brainstem blood supply description. Posterior cerebral artery is #6, and midbrain is behind it.

It is caused by midbrain infarction as a result of occlusion of the paramedian branches of the posterior cerebral artery or of basilar bifurcation perforating arteries.

Diagnosis

Clinical findings mainly eyeball is down and out ipsilateral lateral squint. Ptosis present. Pupil dilated and fixed as the levator palpebrae superioris nerve supply is disrupted. Contralateral hemiplegia CT scan or MRI might help in delineating the cause or the vessel or region of brain involved in stroke.

History

It carries the name of Sir Hermann David Weber, a German-born physician working in London, who described the condition in 1863. It is unrelated to Sturge-Weber syndrome, Klippel-Trenaunay-Weber syndrome or Osler-Weber-Rendu syndrome. These conditions are named for his son Frederick Parkes Weber.

See also

• Alternating hemiplegia of childhood
• Lateral medullary syndrome
• Lateral pontine syndrome
• Medial medullary syndrome
• Medial pontine syndrome

External links

Classification	ICD-10: G46.3 ICD-9-CM: 344.89 MeSH: D020526 DiseasesDB: 31247

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