Choked in the Night

The close clustering of structures in the brainstem results in several different stroke syndromes. The hallmark of these brain stem syndromes is crossed signs i.e. signs in the limbs on one side of the body in combination with cranial nerve palsies on the contralateral side; if these are found then an MRI is the investigation of choice because a small or early posterior fossa infarct can easily be missed on CT. This case describes an unusual brain stem syndrome and how to diagnose this condition.