Essay --

Wernekink commissure syndrome thirdhand to ischemic stroke severe dysarthria is one of the main characteristics of this syndromeIntroduction subtle midbrain infarcts are relatively rare. Several midbrain syndromes such as Webers, Claudes and Benedikts syndrome had been described extensively before. Because of its rarity, clinicians do non 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 by means of superior cerebellar peduncle in midbrain. Its main characteristics are reversible cerebellar dysfunction, occasional oculo tug signs including internuclear ophtalmoplegia or palatal tremor 1-3.We spread over 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 disciplineA 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 exclude a blood pressure of 162/94 mmHg. He was alert and non 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 find with finger-to-nose, heel-to-shin and rapid alternating movement test on both sides, the le... ...in the adult. reassessment neurologique 98 (6)435-4773. Liu H, Qiao L, He Z (2012) Wernekink commissure syndrome a rare midbrain syndrome. neurological sciences official journal of the Italian Neurological baseball clu b and of the Italian Society of Clinical Neurophysiology 33 (6)1419-1421. doi10.1007/s10072-012-0966-44. Mossuto-Agatiello L (2006) Caudal paramedian midbrain syndrome. neurology 66 (11)1668-1671. doi10.1212/01.wnl.0000218180.03127.115. Zhu Y, Liu HN, Zhang CD (2010) Wernekinck commissure syndrome is a pure midbrain infarction. daybook of clinical neuroscience official journal of the Neurosurgical Society of Australasia 17 (8)1091-1092. doi10.1016/j.jocn.2009.11.032 numeral LegendFig.1. Diffusion-weighted magnetic resonance image (MRI) showed diffusion restriction hardened in the paramedian midbrain (arrowheads).