Case Report: Nothnagel Sindrome

Nothnagel syndrome is a rare neurological disorder characterized by ipsilateral third
cranial nerve palsy, gait ataxia, and cerebellar signs, caused by a lesion in the
mesencephalic tegmentum affecting the oculomotor nuclei and superior cerebellar
peduncles. We present a case of a 43-year-old woman with metabolic disorders and
substance use history who developed compatible symptoms. Brain MRI revealed a left-
sided mesencephalic ischemic lesion. Neurology confirmed the diagnosis, and an
interdisciplinary neurorehabilitation program was initiated, aimed at functional recovery.
After two months of treatment, the patient showed marked improvement, increasing her
Barthel Index from 25 to 80. This case underscores the importance of early diagnosis and
a comprehensive rehabilitation approach, particularly in young patients, where
neuroplasticity plays a key role in achieving meaningful functional gains