"Top of the basilar artery" syndrome and thalamic aphasia: A case report.

Patients with midbrain infarction are usually comatose and have a poor prognosis. We report a case of "top of the basilar artery" syndrome in an 84-year-old right-handed man with infarction of medial basal thalamus, superior colliculus, pretectal area, medial longitudinal fasciculus, oculomotor nucleus, and left occipital lobe documented by magnetic resonance imaging. The clinical manifestations included right homonymous hemianopsia, bilateral oculomotor palsy, spastic dysarthria, and thalamic aphasia, which correlated with radiological findings. The presentation is unusual because of the extent of involvement in a fairly alert patient with a "pseudo-coma" pattern due to bilateral ptosis and thalamic aphasia.