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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 Neurorehabil 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Yavuz P, Solmaz I, Kaya UA, Akgoz A, Oguz KK, Aytac S, Ozen S, Yalnizoglu D. Claude Syndrome in Childhood Associated with Probable Neuro-Behcet Disease. Neuropediatrics 2023; 54:82-87. [PMID: 36564024 DOI: 10.1055/s-0042-1759794] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Claude syndrome is a rare midbrain stroke syndrome characterized by ipsilateral third cranial nerve palsy and contralateral hemiataxia. So far, only a few cases have been reported in childhood. We present two children with Claude syndrome at 9 and 15 years of age. The typical clinical picture was consistent with brain magnetic resonance imaging findings. A thorough investigation regarding the underlying etiology revealed no definite diagnosis but clues suggestive of probable neuro-Behcet disease. Awareness of pediatric neurologists on arterial ischemic stroke has been increasing over the past decades, enabling timely diagnosis and appropriate management of rare childhood cases with midbrain stroke.
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Affiliation(s)
- Pinar Yavuz
- Department of Pediatric Neurology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ismail Solmaz
- Department of Pediatric Neurology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ummusen Akca Kaya
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ayca Akgoz
- Department of Pediatric Radiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Kader K Oguz
- Department of Pediatric Radiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Selin Aytac
- Department of Pediatric Hematology, Hacettepe University Faculty of Medicine, Ankara Turkey
| | - Seza Ozen
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Dilek Yalnizoglu
- Department of Pediatric Neurology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Fénelon G. From Dreams to Hallucinations: Jean Lhermitte's Contribution to the Study of Peduncular Hallucinosis and the Dissociation of States. J Neuropsychiatry Clin Neurosci 2022; 34:16-29. [PMID: 34711070 DOI: 10.1176/appi.neuropsych.20120314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Jean Lhermitte (1877-1959) was one of the pioneers of behavioral neurology, including the field of hallucinations. This article focuses on his work concerning the relationship between hallucinations, sleep, and dreams. From 1910, Lhermitte became interested in sleep and its disorders, particularly narcolepsy and its accompanying symptoms. He also reported on sleep disorders and hallucinations occurring in people with lesions of the diencephalic region ("infundibular syndrome"), and later encephalitis lethargica. In 1922, he described a syndrome of complex, predominantly visual hallucinations in patients with vascular damage to the midbrain, known as peduncular hallucinosis. Twelve historical cases of peduncular hallucinosis, including 10 from Lhermitte, are reviewed. He gave a precise phenomenological description of peduncular hallucinosis, and put forward the hypothesis that the lesion disrupted the anatomy and connections of a center regulating wakefulness and sleep, thus enabling a dissociation of the mechanisms of dream and waking states. Although the pathophysiology of peduncular hallucinosis remains to this day partly obscure, the model of a limited subcortical lesion acting through complex mechanisms and ultimately involving the cortex remains valid. Lhermitte was also a pioneer in characterizing what contemporary sleep specialists call dissociation of states.
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Affiliation(s)
- Gilles Fénelon
- Service de Neurologie, Centre Expert Parkinson, Hôpital Henri Mondor-Albert Chenevier, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France; Département d'Etudes Cognitives, École Normale Supérieure, Paris Sciences et Lettres University, Paris; and Equipe NeuroPsychologie Interventionnelle, Institut Mondor de Recherche Biomédicale, Paris-Est Créteil Val-de-Marne University, Créteil, France
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4
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Tian G, Sun X, Tang J. Oculomotor Nerve Palsy. Neuroophthalmology 2022. [DOI: 10.1007/978-981-19-4668-4_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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5
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Cheong CY, Aung TH, Pang WY, Ng CJ, Yap P. Isolated complete unilateral ptosis with intact extraocular eye movements. Age Ageing 2019; 48:596-597. [PMID: 31044224 DOI: 10.1093/ageing/afz041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 03/17/2019] [Accepted: 04/06/2019] [Indexed: 11/13/2022] Open
Abstract
An 88-year-old woman presented with a 2-day history of inability to open her left eye with no ocular discomfort or blurred vision. She had a long-standing history of diabetes mellitus, hypertension and stroke disease. Examination revealed an isolated complete left eye ptosis with no pupillary involvement and intact extraocular movements. There were no other neurological deficits and fatigability was not elicited. Magnetic resonance imaging of the brain showed an acute infarct of the left red nucleus. Oculomotor nerve fascicles are widely separated in the midbrain before they exit at the interpeduncular fossa. A discrete lesion involving the most caudal fibres of the levator palpebrae is the most likely explanation. Although uncommon, this should be considered in patients with underlying cardiovascular risk factors.
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Affiliation(s)
- Chin Yee Cheong
- Department of Geriatric Medicine, Khoo Teck Puat Hospital, Singapore
- Geriatric Education and Research Institute, Singapore
| | - Than Htun Aung
- Department of Geriatric Medicine, Khoo Teck Puat Hospital, Singapore
| | - Wee Yang Pang
- Department of Geriatric Medicine, Khoo Teck Puat Hospital, Singapore
| | - Chong Jin Ng
- Department of Geriatric Medicine, Khoo Teck Puat Hospital, Singapore
| | - Philip Yap
- Department of Geriatric Medicine, Khoo Teck Puat Hospital, Singapore
- Geriatric Education and Research Institute, Singapore
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Abstract
Oculomotor nerve palsy (ONP) is an important and common clinical diagnosis. Its main features are diplopia and ptosis. Its aetiologies are various and complex. A number of different conditions have been reported to cause ONP, such as diabetes mellitus, aneurysm, tumours, painful ophthalmoplegia, pituitary lesions, cavernous sinus lesions, central nervous system infections, and subarachnoid haemorrhage. A patients needs to undergo several tests in order to establish the correct underlying pathology. In this review, we have summarized the aetiologies of the unilateral ONP, and discussed their relative clinical features, pathogenesis, diagnostic criteria, treatment options, and prognosis. We searched PubMed for papers related to ONP and its aetiologies, and selected the publications, which seemed appropriate.
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Affiliation(s)
- Hafiz Khuram Raza
- a School of International Education , Xuzhou Medical University , Xuzhou , China
| | - Hao Chen
- b Department of Neurology , The Affiliated Hospital of Xuzhou Medical University , Xuzhou , China
| | | | - Guiyun Cui
- b Department of Neurology , The Affiliated Hospital of Xuzhou Medical University , Xuzhou , China
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Amano E, Komatuzaki T, Ishido H, Ishihara T, Otsu S, Yamada I, Machida A. Pitfalls in the diagnosis of pupil-sparing oculomotor nerve palsy without limb ataxia: A case report of a variant of Claude's syndrome and neuroanatomical analysis using diffusion-tensor imaging. J Clin Neurosci 2017; 47:120-123. [PMID: 29066240 DOI: 10.1016/j.jocn.2017.09.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 09/30/2017] [Indexed: 11/18/2022]
Abstract
Midbrain infarction causing oculomotor nerve palsy with contralateral ataxia is named Claude's syndrome. Herein we report the case of a variant of Claude's syndrome, which shows pupil-sparing oculomotor nerve palsy without the accompanying neurological deficits other than subtle truncal ataxia. MRI and Diffusion Tensor Imaging revealed that midbrain infarction was located rostrally above the decussation of the superior cerebellar peduncle (SCP) and might have partially destructed the tectospinal tract, which resulted in the absence of limb ataxia and presence of subtle truncal ataxia. In this variant of Claude's syndrome, we should carefully assess truncal ataxia to avoid misdiagnosing it as isolated pupil-sparing oculomotor nerve palsy because the patient showed apparently normal gait and truncal ataxia was only revealed by unstable tandem gait.
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Affiliation(s)
- Eiichiro Amano
- Tsuchiura Kyodo General Hospital, Department of Neurology, 4-1-1 Otsuno, Tsuchiura-shi, Ibaraki 300-0028, Japan.
| | - Tetsuya Komatuzaki
- Tsuchiura Kyodo General Hospital, Department of Radiology, 4-1-1 Otsuno, Tsuchiura-shi, Ibaraki 300-0028, Japan
| | - Hideaki Ishido
- Tsuchiura Kyodo General Hospital, Department of Neurology, 4-1-1 Otsuno, Tsuchiura-shi, Ibaraki 300-0028, Japan
| | - Tasuku Ishihara
- Tsuchiura Kyodo General Hospital, Department of Neurology, 4-1-1 Otsuno, Tsuchiura-shi, Ibaraki 300-0028, Japan
| | - Shinichi Otsu
- Tsuchiura Kyodo General Hospital, Department of Neurology, 4-1-1 Otsuno, Tsuchiura-shi, Ibaraki 300-0028, Japan
| | - Ichiro Yamada
- Tokyo Medical and Dental University, Department of Radiology, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan.
| | - Akira Machida
- Tsuchiura Kyodo General Hospital, Department of Neurology, 4-1-1 Otsuno, Tsuchiura-shi, Ibaraki 300-0028, Japan.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Abstract
An 80-year-old man with angina pectoris abruptly developed Claude's syndrome, which consisted of left-sided partial oculomotor nerve palsy without ptosis and right-sided hemiataxia. There were no other neurological abnormalities. Cranial magnetic resonance imaging indicated an infarction of the left inferior paramedian mesencephalic artery, which may have involved the most caudal portion of the oculomotor fascicules. With anti-platelet therapy, the patient became asymptomatic within 10 days. The oculomotor fascicular arrangement in humans remains unclear. Our case suggests that in the oculomotor fascicles, the fibers to the levator palpebrae superioris may be located more in the rostral region than previously hypothesized.
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Affiliation(s)
- Hiromasa Tsuda
- Department of Neurology, Tokyo Metropolitan Health and Medical Corporation Toshima Hospital, Japan
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10
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Abstract
Over the past few decades it has been recognized that traumatic brain injury may result in various movement disorders. In survivors of severe head injury, post-traumatic movement disorders were reported in about 20%, and they persisted in about 10% of patients. The most frequent persisting movement disorder in this population is kinetic cerebellar outflow tremor in about 9%, followed by dystonia in about 4%. While tremor is associated most frequently with cerebellar or mesencephalic lesions, patients with dystonia frequently have basal ganglia or thalamic lesions. Moderate or mild traumatic brain injury only rarely causes persistent post-traumatic movement disorders. It appears that the frequency of post-traumatic movement disorders overall has been declining which most likely is secondary to improved treatment of brain injury. In patients with disabling post-traumatic movement disorders which are refractory to medical treatment, stereotactic neurosurgery can provide long-lasting benefit. While in the past the primary option for severe kinetic tremor was thalamotomy and for dystonia thalamotomy or pallidotomy, today deep brain stimulation has become the preferred treatment. Parkinsonism is a rare consequence of single head injury, but repeated head injury such as seen in boxing can result in chronic encephalopathy with parkinsonian features. While there is still controversy whether or not head injury is a risk factor for the development of Parkinson's disease, recent studies indicate that genetic susceptibility might be relevant.
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Affiliation(s)
- Joachim K Krauss
- Department of Neurosurgery, Medical School Hannover, Hannover, Germany.
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11
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Abstract
We herein report the case of an 81-year-old woman with midbrain infarction causing pupil-sparing oculomotor nerve palsy with ipsilateral cerebellar ataxia. The lesion was located at the rostral end of the decussation of the superior cerebellar peduncle touching the dorsal side, further caudal and dorsal to causal lesions of Claude's syndrome, which presented as oculomotor palsy and contralateral cerebellar ataxia. This is the third report of midbrain infarction causing partial oculomotor nerve palsy with ipsilateral cerebellar ataxia. It may be possible to establish this entity as a new syndrome following the accumulation of more cases.
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Vitošević Z, Marinković S, Ćetković M, Štimec B, Todorović V, Kanjuh V, Milisavljević M. Intramesencephalic course of the oculomotor nerve fibers: microanatomy and possible clinical significance. Anat Sci Int 2012; 88:70-82. [DOI: 10.1007/s12565-012-0166-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Accepted: 11/28/2012] [Indexed: 02/01/2023]
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13
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Ruchalski K, Hathout GM. A medley of midbrain maladies: a brief review of midbrain anatomy and syndromology for radiologists. Radiol Res Pract 2012; 2012:258524. [PMID: 22693668 DOI: 10.1155/2012/258524] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Accepted: 03/23/2012] [Indexed: 12/29/2022] Open
Abstract
The midbrain represents the uppermost portion of the brainstem, containing numerous important nuclei and white matter tracts, most of which are involved in motor control, as well as the auditory and visual pathways. Notable midbrain nuclei include the superior and inferior colliculus nuclei, red nucleus, substantia nigra, oculomotor nuclear complex, and trochlear nucleus. In addition, white matter tracts include the brachium conjunctivum, medial and lateral lemniscus, spinothalamic tracts, and the fiber tracts within the cerebral peduncles. Although neurologically vital, many of these small midbrain nuclei and white matter tracts are not easily individually identified on neuroimaging. However, given their diverse functions, midbrain pathology often leads to distinct clinical syndromes. A review and understanding of the location and relationships between the different midbrain nuclei and fiber tracts will allow more precise correlation of radiologic findings with patient pathology and symptomatology. Particular syndromes associated with midbrain pathology include the Weber, Claude, Benedikt, Nothnagel, and Parinaud syndromes. The oculomotor and trochlear cranial nerves also reside at this level. An understanding of their functions as well as their projected courses from the midbrain towards the eye allows identification of distinct locations which are particularly vulnerable to pathology.
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Deluca C, Moretto G, Di Matteo A, Cappellari M, Fiaschi A, Tinazzi M; Study Group. Hemi- and monoataxia in cerebellar hemispheres and peduncles stroke lesions: topographical correlations. Cerebellum 2012; 11:917-24. [PMID: 22351351 DOI: 10.1007/s12311-012-0362-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Limb ataxia of sudden onset is due to a vascular lesion in either the cerebellum or the brainstem (posterior circulation, PC, territory). This sign can involve both the upper and the lower limb (hemiataxia) or only one limb (monoataxia). The topographical correlates of limb ataxia have been studied only in brainstem strokes. Therefore, it is not yet known whether this sign is useful to localize the lesion within the entire cerebellar system, both the cerebellar hemisphere and the cerebellar brainstem pathways. Limb ataxia was semi-quantified according to the International Cooperative Ataxia Rating Scale in 92 consecutive patients with acute PC stroke. Limb ataxia was present in 70 patients. Four topographical patterns based on magnetic resonance imaging findings were identified: picaCH pattern (posterior inferior cerebellar artery infarct); scaCH pattern (superior cerebellar artery infarct); CH/CP pattern (infarct involving both the cerebellum and the brainstem cerebellar pathways); and CP pattern (infarct involving the brainstem cerebellar pathways). Hemiataxia was present in (47/70; 67.1%) and monoataxia in (23/70; 32.9%) of patients. Monoataxia involved the upper limb in (19/70; 27.1%) and the lower limb in (4/70; 5.7%) of patients. Limb ataxia usually localized the lesion ipsilaterally (picaCH, scaCH, CH/CP, and CP patterns involving the medulla and sometimes the pons) (53/70; 75.7%), but it might be due also to contralateral (CP pattern involving the pons or midbrain) (16/70; 22.9%) or bilateral lesions (1/70). Limb ataxia usually localizes the lesion ipsilaterally but the infarct might be sometimes contralateral. The occurrence of monoataxia may suggest that the cerebellar system is somatotopically organized.
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Abstract
Claude's syndrome is a distinctive brainstem syndrome characterized by ipsilateral third cranial nerve palsy with contralateral hemiataxia and is due to an intrinsic or extrinsic lesion in the midbrain. We report a case of Claude's syndrome caused by neurocysticercosis infection. A 68 year-old Asian man was admitted to our hospital because of ataxia, left ptosis, and diplopia. Brain magnetic resonance imaging (MRI) showed a cystic lesion in the midbrain, which was surrounded by ring enhancement and peripheral edema. Neurocysticercosis infection was diagnosed by the cerebral spinal fluid study. The patient was treated with albendazole and steroids. A follow-up brain MRI three months later demonstrated the disappearance of a surrounding brain edema and rim enhancement. The most common cause of Claude's syndrome is cerebrovascular disease and malignancy. However, there is no report caused by neurocysticercosis infection. Therefore, if we encounter Claude's syndrome, we should consider neurocysticercosis infection as one of the etiologic factors.
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Affiliation(s)
- Tae-Jin Song
- Department of Neurology, JungAng General Hospital, Jeju, Korea
| | - Sang Hyun Suh
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hanna Cho
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung-Yul Lee
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Abstract
The brainstem consists of the midbrain, pons, and medulla. The cerebellum is attached to the dorsal surface of the pons and upper medulla. The brainstem contains 9 of the 12 cranial nerves and is crossed by ascending, descending, and cerebellar pathways and their nuclei as well as the reticular formation. Numerous and rare crossed brainstem syndromes have been described in recent years, many of them without clinical significance. The aim of this article is to provide a brief clinical description of some conditions affecting the brainstem.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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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] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Thurtell MJ, Leigh RJ, Halmagyi GM. Monocular ophthalmoplegia and partial supranuclear vertical gaze palsy due to unilateral paramedian rostral midbrain infarction. J Neurol 2009; 256:664-6. [PMID: 19444539 DOI: 10.1007/s00415-009-0103-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2008] [Revised: 08/13/2008] [Accepted: 09/03/2008] [Indexed: 11/27/2022]
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Serrano-Pozo A, Montes-Latorre E, González-Marcos JR, Gil-Peralta A. Cardiac embolism in a Claude's syndrome without involvement of the red nucleus. Eur J Neurol 2007; 14:e1-2. [PMID: 17250704 DOI: 10.1111/j.1468-1331.2007.01501.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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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] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Abstract
Brainstem infarcts comprise approximately 10% of all first ischemic brain strokes. The extrinsic vascular supply to the stem is complex. The intrinsic vascularization of the stem may be conceptualized in terms of four relatively constant and distinct vascular territories designated anteromedial, anterolateral, lateral, and dorsal (or dorsolateral). The anatomic structures found within each intrinsic territory determine the symptomatology associated with infarction of that territory. This territorial anatomy permits the knowledgeable physician to plan an MR imaging examination tailored to the patient's history and to predict the patient's neurologic deficits from the MR imaging findings.
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Affiliation(s)
- Kathleen M Burger
- Department of Neurology, Mount Sinai Medical Center, New York, NY 10029, USA
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24
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Abstract
BACKGROUND We report a case of a 61 year old man with midbrain infarction causing Claude's syndrome attributable to stenosis of the posterior cerebral artery. CASE DESCRIPTION The patient presented with a pupil-sparing left third nerve palsy and contralateral ataxia. A background history of treated hypertension and cigarette smoking was obtained. Magnetic resonance imaging revealed an area of infarction involving the left medial midbrain. Magnetic resonance angiography revealed significant stenosis of the left posterior cerebral artery. Antiplatelet therapy was instituted and the patient made a satisfactory recovery. CONCLUSIONS This is the first reported case of Claude's syndrome arising in association with stenosis of the posterior cerebral artery. Intracranial large vessel disease should be considered as a potential aetiologic factor in patients with similar midbrain ischaemia.
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Affiliation(s)
- T Dhanjal
- University Department of Medicine, Western Infirmary, Glasgow, G11 6NT
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