Weber Syndrome

What is Weber syndrome?

Weber syndrome happens when damage to your midbrain causes paralysis on one side of your body (hemiplegia). At the same time, it causes eye and eyelid movement issues affecting the opposite eye. Weber syndrome is rare.

Stroke is often the underlying cause of Weber syndrome, but other conditions can also damage your midbrain.

The midbrain is the topmost part of your brainstem — the connection between your brain and spinal cord. Two of your 12 cranial nerves stem from your midbrain — the oculomotor and trochlear nerves. They’re responsible for eye and eyelid movement. This is why the syndrome causes eye movement issues.

What are the symptoms of Weber syndrome?

The symptoms — or features — of Weber syndrome include:

• Drooping eyelid (ptosis) of one eye.
• The affected eye points downward and outward.
• Double vision (diplopia).
• Partial or complete weakness (paralysis) of your arm and leg on one side of your body.

Get immediate medical help if you have these symptoms or other symptoms of stroke, like slurred speech, loss of sensation, loss of vision, balance issues and facial droopiness.

Some people with Weber syndrome also have coordination issues (ataxia).

Weber syndrome alone typically doesn’t affect your mental functions (thinking). But you may have other symptoms if the damage affects other parts of your brain. For example, Weber syndrome often happens alongside a pontine stroke (a stroke in your pons). This has additional symptoms.

What causes Weber syndrome?

Damage (a lesion) in a specific portion (ventromedial) of your midbrain leads to Weber syndrome. This type of damage most often results from a stroke. But it can also develop from:

• Brain aneurysm.
• Brain bleed (hemorrhage).
• Brain tumor.
• Demyelinating diseases (like multiple sclerosis).

What are the risk factors for Weber syndrome?

Stroke is the most common cause of Weber syndrome. So, risk factors for Weber syndrome are the same as risk factors for stroke. They include:

• High blood pressure (hypertension).
• High cholesterol (hyperlipidemia).
• Diabetes.
• Smoking.

If you have stroke risk factors, it’s important to see your healthcare provider regularly to make sure you’re getting proper treatment for them.

How is Weber syndrome diagnosed?

Stroke is often the underlying cause of Weber syndrome. So, your healthcare provider’s priorities will be diagnosing stroke and getting you immediate treatment. They’ll do a neurological exam and order a CT scan of your brain. They may also recommend a scan to evaluate the blood vessels of your head and neck and a brain MRI.

Your provider will diagnose Weber syndrome if you have its characteristic symptoms and evidence of midbrain damage in imaging tests.

What is the treatment for Weber syndrome?

The initial treatment for Weber syndrome is addressing the underlying cause (usually a stroke). Your healthcare team will work quickly to manage your breathing (airway) and restore blood flow (circulation) in your brain. You may need brain surgery (neurosurgery).

Treatment for Weber syndrome specifically mainly involves rehabilitation strategies.

Rehabilitation for Weber syndrome

Rehabilitation is a major part of recovery for most people who’ve had a stroke. It helps you recover or adapt to the changes in your brain. You may work with a dedicated stroke rehabilitation team and/or a physical therapist. They’ll want to start your rehabilitation as soon as possible.

Rehabilitation for Weber syndrome and midbrain strokes may include:

• Range-of-motion exercises for paralyzed limbs.
• Exercises to help balance and coordination issues.
• Visual testing and exercises to improve double vision.
• Bladder training if you have urinary incontinence.
• Medication or other interventions to manage existing stroke risk factors and help prevent another stroke.

What is the prognosis for someone with Weber syndrome?

The prognosis (outlook) for someone with Weber syndrome depends on several factors, including:

• What caused it.
• How soon you receive treatment.
• If you just have Weber syndrome or have damage in other parts of your brain.
• How well you can prevent future strokes.

People who just have Weber syndrome without other forms of brain damage usually have a better prognosis. Starting rehabilitation early is also key to a better prognosis.

With rehabilitation, some people regain movement in their affected limbs and eye. Others may have permanent movement issues and other neurological complications.

Your healthcare team will be able to give you a better idea of what to expect based on your unique situation.

What are the possible complications of Weber syndrome?

You’re more likely to have complications from Weber syndrome specifically if you can’t leave your bed. This is why your healthcare team will encourage movement as soon as it’s safe. Complications could include:

• Muscle rigidity and contractures (muscle tightening).
• Bedsores.
• Aspiration pneumonia.
• Deep vein thrombosis.
• Pulmonary embolism.
• Urinary tract infections (UTIs).