Case History—A 78 yr old woman presenting with brainstem signs following a seizure.

Brainstem syndromes typically cause ipsilateral cranial nerve lesions and contralateral long tract signs. They are commonly due to brainstem ischaemia, but can also be caused by neoplasia, demyelination, infective and hamartomatous lesions. Imaging, ideally with MRI rather than CT, is obligatory and only then—and possibly following other investigations to identify systemic abnormality or cerebrospinal fluid changes—can appropriate therapy be introduced....

Case History—A 78 yr old woman presenting with brainstem signs following a seizure.

Brainstem syndromes typically cause ipsilateral cranial nerve lesions and contralateral long tract signs. They are commonly due to brainstem ischaemia, but can also be caused by neoplasia, demyelination, infective and hamartomatous lesions. Imaging, ideally with MRI rather than CT, is obligatory and only then—and possibly following other investigations to identify systemic abnormality or cerebrospinal fluid changes—can appropriate therapy be introduced....