We describe herein a case with left-side ptosis induced by pure midbrain infarction in a 49-year-old woman. She also presented with diplopia and right-side cerebellar ataxia. MRI demonstrated new ischemic stroke of the left ventral paramedian midbrain. In this case, ischemia of the left oculomotor fascicles caused the left-side ptosis and diplopia, and ischemia of the left decussation of the superior cerebellar peduncle caused the right-side cerebellar ataxia. These symptoms resulted from inner superior medial mesencephalic branch infraction. This case offers an educational example that can be explained by models proposed in the past and requires knowledge of neuroanatomy and cerebrovasculature.

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1 1 1 1 要旨 57 MRI CT septic emboli Staphylococcus capitis subs ureolyticus Lemierre Lemierre Lemierre Abstract Lemierre s syndrome complicated by cerebral infarction: a case reportThe case was a 57-year-old male. The patient visited our department with the main complaint of pain in the left side of the neck, fever and facial edema. Disturbance of consciousness, neck stiffness, left hemiparesis and ataxia of the left arm were observed. An examination of the cerebrospinal fluid revealed findings suggestive of bacterial meningitis and a brain MRI showed left cerebellar infarction as well as occlusion from the left transverse sinus to the left internal jugular vein. A chest CT showed multiple septic emboli in both lungs. Staphylococcus capitis subsp. ureolyticus was detected from a blood culture and Lemierre s syndrome was diagnosed. Antibiotic drug treatment was given with ceftriaxone, vancomycin, and meropenem and the signs of infection eased. Lemierre s syndrome is a rarely occurring disease, but it has a variety of symptoms and delayed diagnosis that can be fatal. Cerebral infarction can also occur as seen in this case, thus and the possibility of Lemierre s syndrome must be considered when patients present with cerebral infarction and signs of infection. Lemierre 1 (Jpn J Stroke 41: 483-487, 2019)