Case Report Volume 5 Issue 5

A Case of Wernekink Commissure Syndrome

Aswath Venugopal1*, Elizabeth J2, Sumesh Raj2 and Manoj P3

1Post Graduate Resident, Department of General Medicine, Sree Gokulam Medical College and Research Foundation, India
2Professor, Department of General Medicine, Sree Gokulam Medical College and Research Foundation, India
3Consultant Neurologist, Department of Neuromedicine, Sree Gokulam Medical College and Research Foundation, India

*Corresponding Author: Aswath Venugopal, Post Graduate Resident, Department of General Medicine, Sree Gokulam Medical College and Research Foundation, India.

Received: February 20, 2024; Published: April 17, 2024


This is a case of a lady who presented with slurring of speech and swaying while walking for 3 days. She is a known case of Diabetes Mellitus, Hypertension and dyslipidemia and is on treatment for it. Examination showed left side Internuclear ophthalmoplegia and bilateral cerebellar ataxia. MRI showed FLAIR hyperintensity in tegmentum of left caudal midbrain showing diffusion restriction. The patient was diagnosed with Wernekink commissure syndrome based on the clinical features and MRI findings. The patient was started on antiplatelets along with other treatment. The point of interest in this case is it is an extremely rare disease with only few case reports reported and its presentation with bilateral cerebellar symptoms makes it extremely difficult to localize the lesion . Unilateral INO in some cases may help to narrow down the differentials.

Keywords: Wernekink Commissure; INO; Cerebellum; MRI


  1. Savoia S., et al. “Wernekinck commissure syndrome: sequela of a caudal paramedian midbrain infarction”. Neurology: Clinical Practice3 (2021): e363-364.
  2. Zhou C., et al. “Wernekink commissure syndrome secondary to bilateral caudal paramedian midbrain infarction presenting with a unique “heart or V” appearance sign: case report and review of the literature”. Frontiers in Neurology 8 (2017): 376.
  3. Voogd J and van Baarsen K. “The horseshoe-shaped commissure of Wernekinck or the decussation of the brachium conjunctivum methodological changes in the 1840s”. The Cerebellum 13 (2014): 113-120.
  4. Liu H., et al. “Wernekink commissure syndrome: a rare midbrain syndrome”. Neurological sciences 33 (2012): 1419-1421.
  5. Goyal M., et al. “Hypertrophic olivary degeneration: metaanalysis of the temporal evolution of MR findings”. American Journal of Neuroradiology6 (2000): 1073-1077.
  6. Tilikete C and Desestret V. “Hypertrophic olivary degeneration and palatal or oculopalatal tremor”. Frontiers in Neurology 8 (2017): 302.
  7. Aswath V. Author’s personal collection, MRI DWI of patient.
  8. Aswath V. Author’s personal collection, ADC of patient.
  9. Aswath V. Author’s personal collection, MRI FLAIR of patient.


Citation: Aswath Venugopal., et al. “A Case of Wernekink Commissure Syndrome".Acta Scientific Clinical Case Reports 5.5 (2024): 14-16.


Copyright: © 2024 Aswath Venugopal., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Acceptance rate32%
Acceptance to publication20-30 days
Impact Factor1.014

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