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Ham CR, Kim YW, Park JM. The Effect of Elastic Eyelid Band Application on Bilateral Severe Ptosis in a Patient With Bilateral Incomplete Claude's Syndrome: A Case Report. BRAIN & NEUROREHABILITATION 2023; 16:e29. [PMID: 38047092 PMCID: PMC10689863 DOI: 10.12786/bn.2023.16.e29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/03/2023] [Accepted: 10/26/2023] [Indexed: 12/05/2023] Open
Abstract
Patients with brainstem stroke can present with various oculomotor disorders, including ptosis. Neurogenic ptosis, which results from total or partial dysfunction of the third cranial nerve and/or the Müller muscle, can significantly restrict activities of daily living and participation in rehabilitation. Therefore, surgical intervention is an effective therapeutic strategy. However, owing to complications associated with incomplete eyelid closure, such as exposure keratitis and corneal injury, patients with neurogenic ptosis should first be observed, as natural recovery without surgery can be expected despite a poor prognosis. We reported the case of a 66-year-old woman with bilateral Claude syndrome who presented with severe bilateral ptosis, quadriparesis, and cognitive impairment after a bilateral midbrain infarction. After 3 months of intensive rehabilitation using soft elastic eyelid bands, her ptosis improved without the need for eyelid bands and visual field significantly increased, with improved functional level to the point of walking independently without assistance. This report demonstrates the potential advantages of the simple yet effective nonsurgical intervention of a soft elastic eyelid band for ptosis to restore significant functional gains in patients with severe bilateral ptosis after acute stroke.
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Affiliation(s)
- Cho Rom Ham
- Department of Rehabilitation Medicine, and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Wook Kim
- Department of Rehabilitation Medicine, and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jong Mi Park
- Department of Rehabilitation Medicine, and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea
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Adhikari A, Bhattarai AM, Pandit A, Rokaya P, Khadka M, Shahi M, Baiju S, Poudel R. Benedikt syndrome in a 74-year-old hypertensive woman: A case report. Clin Case Rep 2022; 10:e6767. [PMID: 36545564 PMCID: PMC9764039 DOI: 10.1002/ccr3.6767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 11/19/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022] Open
Abstract
Benedikt syndrome is a rare neurological disorder of the midbrain. Herein, we present a case of Benedikt syndrome, who presented with left-sided body weakness, right oculomotor nerve palsy, cerebellar ataxia, and Holmes tremor in the left upper limb following midbrain infarction. She was treated with aspirin, clopidogrel, and amiodarone.
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Affiliation(s)
| | | | - Ayushma Pandit
- Nepalese Army Institute of Health SciencesKathmanduNepal
| | - Pooja Rokaya
- Nepalese Army Institute of Health SciencesKathmanduNepal
| | - Manoj Khadka
- Nepalese Army Institute of Health SciencesKathmanduNepal
| | | | - Swastika Baiju
- Nepalese Army Institute of Health SciencesKathmanduNepal
| | - Raju Poudel
- Department of NeurologyGrande International HospitalKathmanduNepal
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3
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Triarhou LC, Manto M. Nothnagel Syndrome. CEREBELLUM (LONDON, ENGLAND) 2022:10.1007/s12311-022-01437-w. [PMID: 35817948 DOI: 10.1007/s12311-022-01437-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The internist Hermann Nothnagel (1841-1905) took a special interest in the cerebellum. In an early experimental study on rabbits conducted in 1876, he demonstrated the involvement of the vermis in the pathophysiology of motor ataxia. Between 1879 and 1889, he reported four cases of tectal tumors that clinically manifested with bilateral ophthalmoplegia and unilateral gait ataxia, culminating in the Cerebellar Classic highlighted here. Nothnagel attributed this clinical syndrome to lesions of the colliculi ("quadrigeminal bodies") and compression of the nuclei of the third cranial nerves, but also left open the possibility of the involvement of neighboring structures, such as the cerebellar vermis. Today, the ataxic component of Nothnagel syndrome is explained by a dorsal midbrain abnormality of either neoplastic or vascular origin, involving the superior cerebellar peduncles, besides the oculomotor nerves.
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Affiliation(s)
- Lazaros C Triarhou
- Sector of Experimental Cognitive Psychology, Department of Psychology, Faculty of Philosophy, Aristotelian University, 54124, Thessaloniki, Greece.
| | - Mario Manto
- Unité des Ataxies Cérébelleuses, CHU-Charleroi, Charleroi, Belgium
- Service des Neurosciences, University of Mons, Mons, Belgium
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Deuschl G, Becktepe JS, Dirkx M, Haubenberger D, Hassan A, Helmich R, Muthuraman M, Panyakaew P, Schwingenschuh P, Zeuner KE, Elble RJ. The clinical and electrophysiological investigation of tremor. Clin Neurophysiol 2022; 136:93-129. [DOI: 10.1016/j.clinph.2022.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 01/05/2022] [Accepted: 01/07/2022] [Indexed: 01/18/2023]
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Catapano JS, Rumalla K, Srinivasan VM, Lawrence PM, Larson Keil K, Lawton MT. A taxonomy for brainstem cavernous malformations: subtypes of midbrain lesions. J Neurosurg 2021:1-20. [PMID: 34920427 DOI: 10.3171/2021.8.jns211694] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 08/03/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Anatomical taxonomy is a practical tool that has successfully guided clinical decision-making for patients with brain arteriovenous malformations. Brainstem cavernous malformations (BSCMs) are similarly complex lesions that are difficult to access and highly variable in size, shape, and position. The authors propose a novel taxonomy for midbrain cavernous malformations based on clinical presentation (syndromes) and anatomical location (identified with MRI). METHODS The taxonomy system was developed and applied to an extensive 2-surgeon experience over a 30-year period (1990-2019). Of 551 patients with appropriate data who underwent microsurgical resection of BSCMs, 151 (27.4%) had midbrain lesions. These lesions were further subtyped on the basis of predominant surface presentation identified on preoperative MRI. Five distinct subtypes of midbrain BSCMs were defined: interpeduncular (7 lesions [4.6%]), peduncular (37 [24.5%]), tegmental (73 [48.3%]), quadrigeminal (27 [17.9%]), and periaqueductal (7 [4.6%]). Neurological outcomes were assessed using modified Rankin Scale (mRS) scores. A postoperative score ≤ 2 was defined as a favorable outcome; a score > 2 was defined as a poor outcome. Clinical and surgical characteristics and neurological outcomes were compared among subtypes. RESULTS Each midbrain BSCM subtype was associated with a recognizable constellation of neurological symptoms. Patients with interpeduncular lesions commonly presented with ipsilateral oculomotor nerve palsy and contralateral cerebellar ataxia or dyscoordination. Peduncular lesions were associated with contralateral hemiparesis and ipsilateral oculomotor nerve palsy. Patients with tegmental lesions were the most likely to present with contralateral sensory deficits, whereas those with quadrigeminal lesions commonly presented with the features of Parinaud syndrome. Periaqueductal lesions were the most likely to cause obstructive hydrocephalus. A single surgical approach was preferred (> 90% of cases) for each midbrain subtype: interpeduncular (transsylvian-interpeduncular approach [7/7 lesions]), peduncular (transsylvian-transpeduncular [24/37]), tegmental (lateral supracerebellar-infratentorial [73/73]), quadrigeminal (midline or paramedian supracerebellar-infratentorial [27/27]), and periaqueductal (transcallosal-transchoroidal fissure [6/7]). Favorable outcomes (mRS score ≤ 2) were observed in most patients (110/136 [80.9%]) with follow-up data. No significant differences in outcomes were observed between subtypes (p = 0.92). CONCLUSIONS The study confirmed the authors' hypothesis that taxonomy for midbrain BSCMs can meaningfully guide the selection of surgical approach and resection strategy. The proposed taxonomy can increase diagnostic acumen at the patient bedside, help identify optimal surgical approaches, enhance the consistency of clinical communications and publications, and improve patient outcomes.
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Bhatia H, Kaur N, Kaur R. Weber's syndrome in an HIV positive patient: Revisiting the concentric and eccentric target signs - Answer paper. J Clin Neurosci 2021; 87:168-171. [PMID: 33715939 DOI: 10.1016/j.jocn.2021.02.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Harsimran Bhatia
- Department of Radiodiagnosis, Government Medical College and Hospital, Sector 32, Chandigarh, India; Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, India.
| | - Narinder Kaur
- Department of Radiodiagnosis, Government Medical College and Hospital, Sector 32, Chandigarh, India
| | - Ravinder Kaur
- Department of Radiodiagnosis, Government Medical College and Hospital, Sector 32, Chandigarh, India
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Witsch J, Narula R, Amin H, Schindler JL. Mystery Case: Bilateral Claude syndrome. Neurology 2019; 93:599-600. [DOI: 10.1212/wnl.0000000000008176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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8
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Prasad S. A Window to the Brain: Neuro-Ophthalmology for the Primary Care Practitioner. Am J Med 2018; 131:120-128. [PMID: 29079403 DOI: 10.1016/j.amjmed.2017.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 10/03/2017] [Accepted: 10/03/2017] [Indexed: 10/18/2022]
Abstract
Visual symptoms, including acute monocular visual loss, papilledema, visual field deficits, anisocoria, limitations of eye movements, and nystagmus, can be the presenting feature of a wide range of important neurologic diseases. It is important for primary care clinicians to be to be able to direct appropriate initial diagnostic assessment, treatment, and referral for further evaluation of these conditions.
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Affiliation(s)
- Sashank Prasad
- Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
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9
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Bateman JR, Murty P, Forbes M, Collier KY, Tememe D, Marchena OD, Powers WJ. Pupil-sparing third nerve palsies and hemiataxia: Claude's and reverse Claude's syndrome. J Clin Neurosci 2016; 28:178-80. [PMID: 26883351 DOI: 10.1016/j.jocn.2015.12.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 12/17/2015] [Indexed: 11/19/2022]
Abstract
We report two patients with midbrain infarction with pupil-sparing third nerve palsies and hemiataxia: one with contralateral ataxia (Claude's syndrome) and one with ipsilateral ataxia (which we refer to as reverse Claude's syndrome). We highlight the importance of a thorough neurologic evaluation with partial oculomotor palsies and describe, to our knowledge, the fourth account in the literature of a pupil-sparing third nerve palsy with ipsilateral cerebellar ataxia.
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Affiliation(s)
- James R Bateman
- Department of Neurology, University of North Carolina School of Medicine, 170 Manning Drive Campus Box 7025, Chapel Hill, NC 27599-7025, USA.
| | - Pavan Murty
- Department of Neurology, University of North Carolina School of Medicine, 170 Manning Drive Campus Box 7025, Chapel Hill, NC 27599-7025, USA
| | - Michael Forbes
- Department of Neurology, University of North Carolina School of Medicine, 170 Manning Drive Campus Box 7025, Chapel Hill, NC 27599-7025, USA
| | - Kisha Young Collier
- Department of Neurology, University of North Carolina School of Medicine, 170 Manning Drive Campus Box 7025, Chapel Hill, NC 27599-7025, USA; Department of Neurology, Vanderbilt University Medical Center, Nashville, TN 37232-8552, USA
| | - Danoushka Tememe
- Department of Neurology, University of North Carolina School of Medicine, 170 Manning Drive Campus Box 7025, Chapel Hill, NC 27599-7025, USA
| | - Octavio de Marchena
- Department of Neurology, University of North Carolina School of Medicine, 170 Manning Drive Campus Box 7025, Chapel Hill, NC 27599-7025, USA
| | - William J Powers
- Department of Neurology, University of North Carolina School of Medicine, 170 Manning Drive Campus Box 7025, Chapel Hill, NC 27599-7025, USA
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Choi KD, Lee H, Kim JS. Ischemic syndromes causing dizziness and vertigo. HANDBOOK OF CLINICAL NEUROLOGY 2016; 137:317-40. [PMID: 27638081 DOI: 10.1016/b978-0-444-63437-5.00023-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Dizziness/vertigo and imbalance are the most common symptoms of vertebrobasilar ischemia. Even though dizziness/vertigo usually accompanies other neurologic symptoms and signs in cerebrovascular disorders, a diagnosis of isolated vascular vertigo is increasing markedly by virtue of recent developments in clinical neurotology and neuroimaging. It is important to differentiate isolated vertigo of a vascular cause from more benign disorders involving the inner ear, since therapeutic strategies and prognosis differ between these two conditions. Over the last decade, we have achieved a marked development in the understanding and diagnosis of vascular dizziness/vertigo. Introduction of diffusion-weighted magnetic resonance imaging (MRI) has greatly enhanced detection of infarctions in patients with vascular dizziness/vertigo, especially in the posterior-circulation territories. However, well-organized bedside neurotologic evaluation is even more sensitive than MRI in detecting acute infarction as a cause of spontaneous prolonged vertigo. Furthermore, detailed evaluation of strategic infarctions has elucidated the function of various vestibular structures of the brainstem and cerebellum. In contrast, diagnosis of isolated labyrinthine infarction still remains a challenge. This diagnostic difficulty also applies to isolated transient dizziness/vertigo of vascular origin. Regarding the common nonlacunar mechanisms in the acute vestibular syndrome from small infarctions, individual strategies may be indicated to prevent recurrences of stroke in patients with vascular vertigo.
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Affiliation(s)
- K-D Choi
- Department of Neurology, College of Medicine, Pusan National University Hospital, Busan, Korea
| | - H Lee
- Department of Neurology, Keimyung University School of Medicine, Daegu, Korea
| | - J-S Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Korea.
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Síndrome de Benedikt secundario a trauma craneoencefálico. Presentación de un caso y revisión de la literatura. REVISTA MÉDICA DEL HOSPITAL GENERAL DE MÉXICO 2014. [DOI: 10.1016/j.hgmx.2014.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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12
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Roper-Hall G. Historical vignette: Henri Parinaud (1844-1905): French ophthalmologist and pioneer in neuroophthalmology. THE AMERICAN ORTHOPTIC JOURNAL 2014; 64:126-133. [PMID: 25313123 DOI: 10.3368/aoj.64.1.126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Maduri R, Barbagallo G, Iofrida G, Signorelli M, Signorelli F. Regression of Benedikt's syndrome after single-stage removal of mesencephalic cavernoma and temporal meningioma: a case report. Clin Neurol Neurosurg 2012; 115:748-50. [PMID: 22824723 DOI: 10.1016/j.clineuro.2012.06.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Revised: 06/20/2012] [Accepted: 06/24/2012] [Indexed: 11/25/2022]
Affiliation(s)
- Rodolfo Maduri
- Cattedra ed U.O. di Neurochirurgia, Università degli Studi di Catanzaro Magna Græcia, Catanzaro, Italy
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Paidakakos NA, Rokas E, Theodoropoulos S, Dimogerontas G, Konstantinidis E. Posttraumatic Benedikt's syndrome: a rare entity with unclear anatomopathological correlations. World Neurosurg 2012; 78:715.e13-5. [PMID: 22484069 DOI: 10.1016/j.wneu.2012.03.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2011] [Revised: 01/18/2012] [Accepted: 03/31/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND This study sought to present a very rare case of a posttraumatic midbrain lesion producing a debilitating constellation of symptoms identified as Benedikt's syndrome. METHODS A 20-year-old woman with traumatic brain injury presented with ipsilateral internal and external ophthalmoplegia, and contralateral hemiataxia, proprioception disturbances, hypertonicity, slight hemiparesis, and hyperactive tendon reflexes. A bibliographic search was performed in PubMed. RESULTS Neuroimaging revealed a left midbrain lesion at the level of the superior colliculi. In the literature, virtually all Benedikt's syndrome cases, which are rare anyway, are due to midbrain infarcts (basilar or posterior cerebral artery branches). There is only one case from 1963, reported as a posttraumatic Benedikt-type dyskinesia (French language). The historical evolution of the anatomopathologic correlations of the syndrome is also discussed. CONCLUSIONS Benedikt's syndrome is a very rare condition, usually of vascular etiology. Our case is just the second one of traumatic pathogenesis ever reported, the first in the English language literature.
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Abstract
Tonic pupils react poorly to light but constrict during viewing of a near stimulus. Adie's name is typically used in association with tonic pupils, but a review of Adie's articles reveals that he described the syndrome of tonic pupils and absent reflexes and not the pupillary abnormality per se. Therefore, it would be more appropriate to refer to a tonic pupil as simply a "tonic pupil" and leave Adie's name for the syndrome.
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Affiliation(s)
- Michael Kelly-Sell
- Division of Neuro-Ophthalmology, Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA
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Wilson MD. The life and times of Thomas Willis and his impact on contemporary medicine. JOURNAL OF THE HISTORY OF THE NEUROSCIENCES 2012; 21:127-131. [PMID: 22428734 DOI: 10.1080/0964704x.2011.595632] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Thomas Willis made numerous contributions to the neurosciences that were broad in scope. In an age of scientific breakthroughs and intellectual revolutions, Willis bestowed upon medical research the clinical rigor that set the stage for subsequent medical breakthroughs. In Cerebri Anatome, Willis introduced a measure of empiricism hitherto unknown in medieval times. By coupling the delineation of brain and neural anatomy with functional studies, Willis brought the science of clinical neurology into fruition. Psychiatry, too, benefited from Willis' elucidation of mental illness and intellectual disability, and modern behavioral psychologists claim Willis as one their early, most ardent champions.
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Jha S, Ansari M, Sonkar K, Paliwal VK. An unusual cause of a midbrain syndrome. J Clin Neurosci 2011. [DOI: 10.1016/j.jocn.2009.11.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Abstract
This chapter covers the very large number of possible disorders that can affect the three ocular motor nerves, the neuromuscular junction, or the extraocular muscles. Conditions affecting the nerves are discussed under two major headings: those in which the site of damage can be anatomically localized (e.g., fascicular lesions and lesions occurring in the subarachnoid space, the cavernous sinus, the superior orbital fissure, or the orbit) and those in which the site of the lesion is either nonspecific or variable (e.g., vascular lesions, tumors, "ophthalmoplegic migraine," and congenital disorders). Specific comments on the diagnosis and management of disorders of each of the three nerves follow. Ocular motor synkineses (including Duane's retraction syndrome and aberrant regeneration) and disorders resulting in paroxysms of excess activity (e.g., neuromyotonia) are then covered, followed by myasthenia gravis and other disorders that affect the neuromuscular junction. A final section discusses disorders of the extraocular muscles themselves, including thyroid disease, orbital myositis, mitochondrial disease, and the muscular dystrophies.
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Affiliation(s)
- Christian J Lueck
- Department of Neurology, The Canberra Hospital, and Australian National University Medical School, Canberra, Australia.
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Abstract
Eye movement abnormalities constitute an important clinical sign that can be a manifestation of dysfunction of cranial nerves III, IV, and VI (the 3 ocular motor nerves). Specific motility deficits often have highly localizing value within the neuroaxis, serving to refine a differential diagnosis and guide management. This article reviews the key anatomic concepts, clinical presentation, differential diagnosis, and management of ocular motor nerve palsies. Dysfunction of an ocular motor nerve must be distinguished from other causes of abnormal eye movements, such as myasthenia gravis or thyroid eye disease, which are outside the scope of this article.
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Affiliation(s)
- Sashank Prasad
- Division of Neuro-Ophthalmology, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
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Randhawa S, Donohue MM, Hamilton SR. Concomitant presentation of three rare mesencephalic syndromes: case report. Clin Neurol Neurosurg 2010; 112:697-700. [PMID: 20434833 DOI: 10.1016/j.clineuro.2010.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2009] [Revised: 01/17/2010] [Accepted: 04/04/2010] [Indexed: 11/26/2022]
Abstract
We describe a unique case of concomitant presentation of three rare mesencephalic syndromes. A 48-year-old man with an acute stoke was found to have an unusual combination of three rare mesencephalic syndromes after detailed neuro-ophthalmic evaluation: the plus-minus lid syndrome, the vertical one-and-a-half syndrome, and Claude's syndrome. We discuss the clinical and anatomical localization of these syndromes. This was corroborated by magnetic resonance imaging (MRI) which revealed areas of infarction at the thalamo-mesencephalic junction and the right rostral midbrain involving the third nerve fascicle and the red nucleus. Our case highlights the importance of a careful ocular motility examination as a tool which has a highly localizing value in the diagnosis of stroke.
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Affiliation(s)
- Sandeep Randhawa
- Department of Ophthalmology, University of Washington, Seattle, WA, USA.
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21
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Liu GT, Volpe NJ, Galetta SL. Eye movement disorders. Neuroophthalmology 2010. [DOI: 10.1016/b978-1-4160-2311-1.00016-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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22
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Liu GT, Volpe NJ, Galetta SL. Eye movement disorders. Neuroophthalmology 2010. [DOI: 10.1016/b978-1-4160-2311-1.00015-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Isolated unilateral ptosis and mydriasis from ventral midbrain infarction. J Neurol 2009; 256:1164-5. [PMID: 19390769 DOI: 10.1007/s00415-009-5054-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2008] [Revised: 12/17/2008] [Accepted: 01/13/2009] [Indexed: 10/20/2022]
Abstract
We report a patient who has a tremor and unilateral ptosis and mydriasis without extraocular muscle paresis from an intra-axial lesion demonstrated on neuroimaging. Previously extraocular muscles sparing partial third nerve palsy has been thought to be due to extra-axial lesion such as vascular compression. Compared to proposed models for arrangement of oculomotor fascicle, this case demonstrates that it is possible to damage the fibers destined for levator and pupillomotor function without affecting the extra-ocular muscles.
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Marx JJ, Thömke F. Classical crossed brain stem syndromes: myth or reality? J Neurol 2009; 256:898-903. [DOI: 10.1007/s00415-009-5037-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2008] [Accepted: 01/28/2009] [Indexed: 10/21/2022]
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Evaluation of Third Nerve Palsy in the Emergency Department. J Emerg Med 2008; 35:239-46. [DOI: 10.1016/j.jemermed.2007.04.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2005] [Revised: 06/27/2006] [Accepted: 11/12/2006] [Indexed: 11/23/2022]
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27
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Salman MS, Froese N, Shuckett P, Wrogemann J, Eisenstat DD. Claude syndrome 'plus' in an adolescent. Can J Neurol Sci 2006; 33:430-2. [PMID: 17168175 DOI: 10.1017/s031716710000545x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Patel R, Jha S, Yadav RK. Pleomorphism of the clinical manifestations of neurocysticercosis. Trans R Soc Trop Med Hyg 2006; 100:134-41. [PMID: 16214195 DOI: 10.1016/j.trstmh.2005.06.028] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2004] [Revised: 06/23/2005] [Accepted: 06/23/2005] [Indexed: 11/21/2022] Open
Abstract
Neurocysticercosis (NCC) remains a major public health problem in developing countries as it is the most common helminthic infection of the central nervous system. Clinical manifestations are non-specific and pleomorphic. Case reports on uncommon presentations of NCC are few. We report six interesting cases of NCC with unusual clinical presentation that demonstrate this spectrum of pleomorphism. These include extrapyramidal disease (parkinsonism and focal dystonia), Kluver-Bucy syndrome, Weber's syndrome, dementia and cortical blindness. The clinical details and possible mechanisms for the uncommon presentations are also discussed. Thus, a high level of suspicion should be kept for NCC, especially in endemic zones and developing countries.
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Affiliation(s)
- R Patel
- Neurology Department, Sanjay Gandhi PGIMS, Lucknow, India
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Caplan L, Chung CS, Wityk R, Glass T, Tapia J, Pazdera L, Chang HM, Dashe J, Chaves C, Vemmos K, Leary M, Dewitt L, Pessin M. New England medical center posterior circulation stroke registry: I. Methods, data base, distribution of brain lesions, stroke mechanisms, and outcomes. J Clin Neurol 2005; 1:14-30. [PMID: 20396469 PMCID: PMC2854928 DOI: 10.3988/jcn.2005.1.1.14] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2005] [Accepted: 03/12/2005] [Indexed: 12/31/2022] Open
Abstract
Among 407 New England Medical Center Posterior Circulation Registry (NEMC-PCR) patients, 59% had strokes without transient ischemic attacks (TIAs), 24% had TIAs before strokes, and 16% had only posterior circulation TIAs. Embolism was the commonest stroke mechanism accounting for 40% of cases (24% cardiac origin, 14% arterial origin, 2% had potential cardiac and arterial sources). In 32%, large artery occlusive lesions caused hemodynamic brain infarction. Stroke mechanisms in the posterior and anterior circulation are very similar. Infarcts most often included the distal posterior circulation territory (rostral brainstem, superior cerebellum and occipital and temporal lobes), while the proximal (medulla and posterior inferior cerebellum) and middle (pons and anterior inferior cerebellum) territories were equally involved. Infarcts that included the distal territory were twice as common as those that included the proximal or middle territories. Most distal territory infarcts were attributable to embolism. Thirty day mortality was low (3.6%). Embolic stroke mechanism, distal territory location, and basilar artery occlusive disease conveyed the worst prognosis.
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Affiliation(s)
- Lr Caplan
- Cerebrovascular Disease Sections of the New England Medical Center, Boston and the Beth Israel Deaconess Medical Center, Boston
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Schwarz U. Neuroophthalmology: a brief Vademecum. Eur J Radiol 2004; 49:31-63. [PMID: 14975493 DOI: 10.1016/j.ejrad.2003.09.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2003] [Revised: 09/08/2003] [Accepted: 09/09/2003] [Indexed: 11/17/2022]
Abstract
The stunning, intricate interaction between the visual, vestibular and optomotor systems--each a miracle on its own--ensures maintenance of orientation in space as well as visual recognition and target selection despite a host of sensory conflicts and adversary disturbances. Their main goals are to keep a target of interest on the fovea by either maintaining or shifting the direction of gaze in order to produce an accurate internal representation of the visual surroundings, in particular the selected target, and to continuously mirror the spatial relationship between these various visual elements and the self. Not surprising, the implementation of this host of elaborate neural networks encompasses almost every part of the brain, including the brainstem, cerebellum, extrapyramidal system and many areas of the cerebral cortex. Thus far, these systems are among the best investigated in brain research; and enormous knowledge was amassed over the last century employing a variety of techniques, including single cell recordings, eye movement studies, functional imaging and neuropsychological observations. In addition, this prolific line of research has enlightened many fundamental principles of neural and neuronal processing, which have subsequently enriched other fields of brain research as well as computational neuroscience, e.g. the discovery of receptive fields, which have now become a ubiquitous concept in many other areas of neurophysiology. This (improperly) brief, fractional and undoubtedly biased Vademecum is meant to accompany the reader into this marvellous field of neurophysiology and neurology. In particular, it stresses the clinical application of its functional neuroanatomy at the bedside, which, in many respects, is superior to other means of investigating a patient.
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Affiliation(s)
- Urs Schwarz
- Neurologische Klinik, Universitätsspital, Frauenklinikstrasse 26, CH 8091 Zürich, Switzerland.
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Samadani U, Umemura A, Jaggi JL, Colcher A, Zager EL, Baltuch GH. Thalamic deep brain stimulation for disabling tremor after excision of a midbrain cavernous angioma. Case report. J Neurosurg 2003; 98:888-90. [PMID: 12691417 DOI: 10.3171/jns.2003.98.4.0888] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Thalamic deep brain stimulation (DBS) has been demonstrated to be effective for the treatment of parkinsonian or essential tremor. To date, however, few data exist to support the application of this method to treat midbrain tremor. A 24-year-old right-handed man underwent radiosurgery and subsequent resection of a recurrently hemorrhaging cavernous angioma located in the left side of the midbrain. The surgery exacerbated severe choreoathetotic resting and action tremors of his right extremities and trunk. The patient underwent placement of a deep brain stimulator into the left ventral intermediate nucleus of the thalamus (Vim). Postoperatively, decreased truncal ataxia and right-sided choreoathetotic tremor were demonstrated, with a 57% increase in dexterity as measured by task testing. The authors demonstrate that DBS can be an effective treatment modality for disabling tremor after resection of a midbrain cavernous angioma.
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Affiliation(s)
- Uzma Samadani
- Department of Neurosurgery and Neurology, Penn Neurological Institute at Pennsylvania Hospital, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19107, USA
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Caplan L. Posterior circulation ischemia: then, now, and tomorrow. The Thomas Willis Lecture-2000. Stroke 2000; 31:2011-23. [PMID: 10926972 DOI: 10.1161/01.str.31.8.2011] [Citation(s) in RCA: 92] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- L Caplan
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
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Affiliation(s)
- G K Leung
- Department of Surgery, University of Hong Kong, Queen Mary Hospital, People's Republic of China
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Borrás JM, Salazar FG, Grandas F. Oculomotor palsy and contralateral tremor (Benedikt's syndrome) following a stereotactic procedure. J Neurol 1997; 244:272-4. [PMID: 9112599 DOI: 10.1007/s004150050085] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Abstract
BACKGROUND Brain infarction secondary to stenosis of the posterior cerebral artery is uncommon. We report a patient with midbrain infarction and symptoms of both Benedikt's and pupil-sparing oculomotor palsy syndromes secondary to posterior cerebral artery stenosis. CASE DESCRIPTION A 51-year-old woman developed diplopia, left ptosis, and right hemiataxia and hyperactive tendon reflexes. Pupils were equal and reactive. Radiological examination revealed stenosis of the posterior cerebral artery and left-sided midbrain infarct. CONCLUSIONS Stenosis of the posterior cerebral artery may cause only midbrain infarction and may be responsible for Benedikt's and pupil-sparing oculomotor palsy syndromes.
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Affiliation(s)
- G W Duncan
- Division of Neurology, Meharry Medical College, Nashville, TN 37208, USA
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