Antiphospholipid antibodies are a major risk factor of juvenile cerebral infarction; in addition, they can cause major arterial stenosis or occlusion. We report a case of a 32-year-old man who had been diagnosed with systemic lupus erythematosus at the age of 20 years, and was admitted to Shin-Oyama City Hospital, Tochigi, Japan, because of left arm weakness. Cerebral infarction and occlusion of the right internal carotid artery were found. Tests were positive for phosphatidylserinedependent antiprothrombin antibody, which can be useful for the diagnosis of antiphospholipid syndrome. Phosphatidylserine-dependent antiprothrombin antibody might have the potential to cause thrombosis and vasculitis-like occlusion.

Medullary hemorrhage is rare, and the causative role of hypertension still remains controversial. Cavernous angioma and other vascular malformations have been reported to cause medullary hemorrhage. A 53-year-old man was admitted to our hospital for vertigo. Medullary hemorrhage and multiple small hypointense lesions were detected on T2-star weighted magnetic resonance imaging (T2*W MRI). One and four months later, the appearance of new lesions confirmed the diagnosis of cerebral cavernous angioma. Cavernous angioma is often characterized by de novo appearance/progression on MRI. A follow-up MRI is required to diagnose cavernous angioma in patients with medullary hemorrhage.

A 43-year-old man was admitted to Shin-Oyama City Hospital, Tochigi, Japan, with vertigo. Neurological examination showed body lateropulsion to the right, decreased thermal sensation in the right side of the face and left trunk including extremities. He did not show Horner syndrome, curtain sign or limb ataxia. Muscle strength and tonus were normal in all extremities. Both pupils were 3 mm. Spontaneous rotatory nystagmus to the left was seen. His eyes were deviated to the right, although he could keep his eyes midposition (Fig. 1a). Eye movements were full, but the eyes deflected to the right while upward saccades. Horizontal conjugate gaze deviation was detected when the eyelid was forcibly opened without warning (Fig. 1b), and on computed tomography under the instruction of eyelid closure (Fig. 1c). After slow blinking, the eyes immediately returned from the right side to mid-position. A right lateral medullary infarction was evident on the second day (Fig. 1d).In lateral medullary infarction patients, ocular lateropulsion refers to tonic horizontal conjugate gaze deviation to the lesion side, which is accentuated under eyelid closure or without fixation; full range of eye movement; asymmetrical amplitude of horizontal saccades; and vertical saccades deflect to the lesion side.1-3 In the present case, the olivocerebellar pathway was likely to be interrupted by the lateral medullary infarction. The pathway that originated in the contralateral inferior olive, after crossing midline, runs in the inferior peduncle to the cerebellar vermis. 2,3 AcknowledgmentThe authors declare no conflict of interest. References

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