Case 23 - Weakness and abnormal eye movements
Clinical formulation
Sudden-onset left hemiplegia and UMN facial weakness with right VI palsy. The best candidate is a right pontine haemorrhage which expanded to affect the midbrain. The alternative is a thrombus in the basilar artery that initially affected the ventral pons and then ascended to the basilar tip causing coma. CT brain, including angiographic sequences, is should be performed immediately - and depending on the results, treatment options may be life-saving.
Outcome