(Kiosk 3) Benedikt Syndrome Post Cardiac Catheterization in a Middle-aged Woman: A Case Report

Case Diagnosis: 56-year-old female patient with Benedikt syndrome due to acute ischemic stroke post cardiac catheterization.

Case Description or Program Description: A 56-year-old female with a past medical history of hypertension and chronic obstructive pulmonary disease (COPD) presented with complaints of dyspnea, cough, and chest pain for one week. She was diagnosed with COPD exacerbation and treated appropriately. An echocardiogram was performed and identified new onset congestive heart failure with reduced ejection fraction (EF).

Left heart catheterization demonstrated dilated cardiomyopathy, an EF of 10-15%, and minimal stenosis. After the procedure, the patient reported double vision with left facial numbness. Upon physical exam, the patient exhibited right eye exotropia with inability to adduct, left-sided intermittent jerking movements, left-sided ataxia, and diffuse hyperreflexia. Brain magnetic resonance imaging (MRI) showed subtle infarcts in the right midbrain and right frontal area.

The patient reported improvements in right eye adduction and choreoathetoid movements by day five, and by day ten, her blurry vision improved. A wearable cardioverter defibrillator was issued, and once medically stabilized, she was transferred to acute inpatient rehabilitation.

Setting: Short term acute care hospital with acute inpatient rehabilitation

Assessment/Results: The patient’s mobility and self-care functions improved steadily in the acute rehabilitation program. She continues to experience visual fatigue and headaches, requiring further evaluation by Neuro-Ophthalmology.

Discussion (relevance): Benedikt syndrome, or paramedian midbrain syndrome, is a rare condition named for specific damage in the midbrain causing ipsilateral oculomotor nerve palsy, contralateral hemiparesis, and contralateral cerebellar ataxia, Holmes tremor, or choreoathetosis. Reported cases of Benedikt syndrome have had slightly variable symptoms, etiology, and lesion location. Neurorehabilitation has been reported to have good results in a patient with Benedikt syndrome secondary to traumatic brain injury.

Conclusions: This case illustrates a unique presentation of Benedikt Syndrome, a rare neurological condition, which was most likely due to plaque embolism secondary to cardiac catheterization.