Pupil sparing Cranial Nerve III Palsy and Hemiparesis, Weber Syndrome: A Case Report and literature review

Midbrain stroke especially Weber syndrome is a rare case seldom reported in the literature. It involves oculomotor nerve palsy and contralateral hemiparesis. A 46-year-old female presented with sudden onset of blurring of vision along with right-sided hemiparesis, right upper motor neuron type cranial nerve (CN) VII palsy, left-sided CN III palsy, and left-sided ptosis. Magnetic resonance imaging (MRI) revealed T2 flair/hyperintensity in the left side of the midbrain, bilateral gangliocapsular regions, and centrum semi vale indicating acute infarct and chronic ischemic changes respectively as well as a high signal area on the T2/FLAIR sequence, indicating sinusitis. Ocular manifestations of a midbrain stroke are highlighted in this case study, particularly Weber syndrome, which also entails contralateral hemiparesis. A better prognosis can be achieved with early diagnosis and treatment. In our case report, a CT scan was found to be normal and the diagnosis of Weber syndrome was made only after MRI confirming its sensitivity to detect intracranial lesions.