BRIEF COMMUNICATION Oculo-pyramidal crossed syndrome heralded by seizure: a case report Francesco Brigo • Giampaolo Tomelleri • Tiziano Zanoni • Giuseppe Maccarrone • Paolo Bovi • Giuseppe Moretto Received: 19 August 2010 / Accepted: 4 April 2011 / Published online: 14 April 2011 Ó Springer-Verlag 2011 Abstract Ischemic oculo-pyramidal crossed syndrome, i.e. amaurosis fugax contralateral to hemiparesis, is caused by an embolus from internal carotid artery occluding the retinal or the ophthalmic artery as well as the middle cerebral artery. We report on a patient with an oculopyramidal cros- sed syndrome due to internal carotid artery dissection and clinically manifesting with amaurosis fugax and seizure. Ischemic lesions can present with symptomatic seizures and, conversely, seizures may precede ischemic strokes, thus being a warning sign of a cerebrovascular event. Keywords Amaurosis fugax Á Seizure Á Oculo-pyramidal crossed syndrome Introduction Ischemic oculo-pyramidal crossed syndrome, i.e. amaurosis fugax contralateral to hemiparesis, is caused by an embolus from internal carotid artery occluding the retinal or the ophtalmic artery and the middle cerebral artery. We report on a patient with an oculo-pyramidal crossed syndrome clini- cally manifesting with amaurosis fugax and partial seizure with secondary generalization. To our knowledge this is the first case of an oculo-pyramidal crossed syndrome clinically manifesting with amaurosis fugax and seizure. Case report A 50-year-old male, with no history of previous disease, including vasculopathy, collagen–vascular diseases, or head or neck trauma, complained of sudden transient monocular visual loss in left eye, which lasted less than 15 min, and followed by him losing consciousness. Nobody witnessed the event. After regaining conscious- ness, the patient was unable to speak and move the right limbs and had tongue bite. After several minutes, both aphasia and right hemiparesis improved to normality. Laboratory data, including screening for hypercoagula- bility, were normal. CT scan, chest X-ray and echocar- diogram were normal. Brain MRI showed multiple recent ischemic lesions in the left frontal cortical region with diffusion restriction (Fig. 1). EEG revealed only mild theta activity on temporal regions, without epileptiform abnormalities. CT-angiogra- phy showed a dissection of left internal carotid artery involving the entire extracranial segment (Fig. 2). Discussion We described a patient with a curious clinical manifesta- tion of an oculo-pyramidal crossed syndrome, in whom amaurosis fugax was followed by partial seizure with secondary generalization. Both amaurosis and seizure were expressions of an ischemic lesion caused by embolisation from left internal carotid artery dissection. F. Brigo Dipartimento di Scienze Neurologiche, Neuropsicologiche, Morfologiche e Motorie, Universita ` di Verona, Verona, Italy G. Tomelleri (&) Á T. Zanoni Á P. Bovi Á G. Moretto SSO Stroke Unit, UO di Neurologia, DAI di Neuroscienze e Istituto di Neurochirurgia, Azienda Opedaliera Universitaria Integrata di Verona, Verona, Italy e-mail: giampaolo.tomelleri@azosp.vr.it G. Maccarrone U.O. di Neurologia, Ospedale di Castelfranco Veneto, Castelfranco Veneto, Italy 123 Neurol Sci (2011) 32:967–968 DOI 10.1007/s10072-011-0585-5