Eight-and-a-half syndrome: a rare presentation

Eight-and-a-half syndrome is a rare entity characterised by conjugate horizontal gaze palsy, ipsilateral internuclear ophthalmoplegia and ipsilateral lower motor neuron type facial palsy. It is due to a lesion affecting median longitudinal fasciculus, paramedian pontine reticular formation and facial nerve fascicle on the same side at the level of pons. The diagnosis is easily missed as it needs detailed ocular movement examination. It is mainly caused due to infarction or demyelinating conditions. We are reporting an interesting case of a 54-year-old man with right-side eight-and-a-half syndrome due to acute ischaemic stroke and ST-elevation myocardial infarction of the inferior wall.

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Complete horizontal gaze palsy due to bilateral paramedian pontine reticular formation involvement as a presentation of multiple sclerosis: a case report

BMC Neurology ◽

10.1186/s12883-019-1494-0 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 1

Author(s):

Amirhossein Akhavan Sigari ◽

Masoud Etemadifar ◽

Mehri Salari

Keyword(s):

Multiple Sclerosis ◽

Reticular Formation ◽

Pontine Reticular Formation ◽

Case Presentation ◽

Eye Motion ◽

Neurology Clinic ◽

Ocular Movement ◽

Horizontal Gaze ◽

Bilateral Lesions ◽

Gaze Palsy

Abstract Background Demyelinating central nervous system diseases include several disorders that multiple sclerosis (MS) is identified as the most common among them. Ocular movement disturbances are a typical presentation in MS patients where lesions affect the complex and interconnected pathways involved in eye motion. Centers for gaze control are located in the pons primarily; therefore, lesions involving these centers can be presented with abnormalities in gaze. However, bilateral lesions in pontine gaze centers are exceptionally rare. Case presentation A 16-year-old girl with bilateral horizontal gaze palsy was referred to the neurology clinic. Magnetic resonance imaging of the patient indicated bilateral hyperintensities in the pons at the level of the paramedian pontine reticular formation. The patient was diagnosed with multiple sclerosis with respect to clinical and imaging findings and managed. Conclusion Ocular movement abnormalities are a commonly encountered manifestation in patients with multiple sclerosis, however, bilateral gaze palsy is an exceptionally rare sign and should guide the physician to contemplate for anticipated lesions in the pons, and suspect MS, especially in childbearing-aged women. Although an extensive workup should also be done to rule out possible mimickers.

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Isolated segmental mega-diverticulosis of ileum: a rare presentation of acute intestinal obstruction

International Surgery Journal ◽

10.18203/2349-2902.isj20172419 ◽

2017 ◽

Vol 4 (6) ◽

pp. 2098

Author(s):

Veena A. ◽

Hanumanthaiah K. S. ◽

Manjunath K. ◽

Sandeep S. ◽

Sai Suraj Kotera

Keyword(s):

Intestinal Obstruction ◽

Terminal Ileum ◽

Interesting Case ◽

Acute Intestinal Obstruction ◽

Rare Entity ◽

Rare Presentation ◽

Pathological Evaluation ◽

Initial Imaging ◽

Operative Findings ◽

Low Prevalence

We present an interesting case of acute intestinal obstruction where a woman, aged 26, presented to emergency room with constipation for 2 days and vomiting for 1 day. The examination and initial imaging suggested sub-acute intestinal obstruction, since the condition progressed she was taken to operating room for laparotomy. The intra-operative findings revealed isolated segmental mega-diverticulosis of ileum. She underwent resection of terminal ileum and caecum with ileo-colic anastomosis. Pathological evaluation of specimen showed diverticular features. Ileal diverticulosis excluding Meckel’s is an extremely rare entity and complicating into acute intestinal obstruction is strange. With a low prevalence and absence of suspicion for it, diagnosis will be made intra operatively most of the time.

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Horizontal gaze palsy with progressive myoclonic epilepsy: Rare presentation of Gaucher′s disease

Neurology India ◽

10.4103/0028-3886.111136 ◽

2013 ◽

Vol 61 (2) ◽

pp. 177 ◽

Cited By ~ 3

Author(s):

Sudhir Sharma ◽

Vivek Lal ◽

Reena Das

Keyword(s):

Myoclonic Epilepsy ◽

Rare Presentation ◽

Horizontal Gaze ◽

Progressive Myoclonic Epilepsy ◽

Gaze Palsy

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Horizontal Gaze Palsy and Rapidly Progressive Scoliosis: Typical Findings in ROBO3 Mutations

Neuropediatrics ◽

10.1055/s-0034-1390618 ◽

2014 ◽

Vol 45 (S 01) ◽

Author(s):

J. Koch ◽

F. Landauer ◽

T. Keindl ◽

M. Sloman

Keyword(s):

Progressive Scoliosis ◽

Horizontal Gaze ◽

Gaze Palsy

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MRI- and neurophysiological findings in a case of Horizontal Gaze Palsy with Progressive Scoliosis (HGPPS)

Neuropediatrics ◽

10.1055/s-2006-974115 ◽

2006 ◽

Vol 37 (06) ◽

Author(s):

O Hußmann ◽

BA Neubauer ◽

A Hahn

Keyword(s):

Progressive Scoliosis ◽

Horizontal Gaze ◽

Gaze Palsy

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Multiple Koenen Tumors, a Rare Entity: Combination Treatment with 1% Topical Sirolimus Electrofulguration and Excision

Skin Appendage Disorders ◽

10.1159/000511743 ◽

2020 ◽

Vol 7 (1) ◽

pp. 66-70

Author(s):

Vishalakshi Viswanath ◽

Jay D. Gupte ◽

Niharika Prabhu ◽

Nilima L. Gour

Keyword(s):

Tuberous Sclerosis ◽

Combination Treatment ◽

Tumor Regression ◽

Surgical Excision ◽

Tumor Formation ◽

Rare Entity ◽

Rare Presentation ◽

Cutaneous Manifestations ◽

Elderly Female

Introduction: Koenen tumors are benign, cutaneous manifestations of tuberous sclerosis. These are disfiguring, painful, and challenging to treat as they frequently recur. We report a case of long-standing, multiple Koenen tumors affecting all twenty nails in an elderly female who was successfully treated with a combination of topical sirolimus 1%, surgical excision, and electrofulguration. Case Report: A 57-year-old lady presented with multiple, asymptomatic periungual, and subungual tumors affecting all twenty nails since 27 years. Cutaneous examination revealed confetti macules, ash-leaf macule, and shagreen patch over trunk. Nail biopsy was compatible with Koenen’s tumor. Computerized tomography of brain showed diffuse patchy sclerosis. The tumors were treated with topical sirolimus 1% ointment for 10 months with excellent regression. Electrofulguration for both great toenails and surgical excision of right thumbnail periungual fibroma was done. 1% sirolimus was advised after the surgical treatment. There were no adverse effects or recurrence of tumors over a 2-year follow-up. Discussion: Topical sirolimus 1% was effective in tumor regression and preventing new tumor formation. Larger tumors that interfered in daily chores were treated with excision and electrofulguration. Thus, a combination treatment for this rare presentation of tuberous sclerosis provided optimum results.

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Pontine cavernous hemangioma presenting with horizontal gaze palsy

The Indian Journal of Pediatrics ◽

10.1007/bf02760595 ◽

2005 ◽

Vol 72 (1) ◽

pp. 86-86 ◽

Cited By ~ 1

Author(s):

Vimla Menon ◽

Rohit Saxena ◽

Zia Chaudhary

Keyword(s):

Cavernous Hemangioma ◽

Horizontal Gaze ◽

Gaze Palsy

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Isolated multidrug-resistant tubercular tenosynovitis of the flexor tendon of the little finger

BMJ Case Reports ◽

10.1136/bcr-2020-238339 ◽

2021 ◽

Vol 14 (2) ◽

pp. e238339

Author(s):

Sunny Chaudhary ◽

Subhajit Maji ◽

Varun Garg ◽

Vivek Singh

Keyword(s):

Flexor Tendon ◽

Extrapulmonary Tuberculosis ◽

Functional Limitation ◽

Clinical Signs ◽

Multidrug Resistant ◽

Interesting Case ◽

Antitubercular Therapy ◽

Histopathological Diagnosis ◽

Rare Presentation ◽

Little Finger

Isolated multidrug-resistant (MDR) tubercular tenosynovitis of the flexor tendons of finger without involvement of wrist is a rare presentation. Tenosynovitis of hand is an uncommon manifestation of extrapulmonary tuberculosis. Pyogenic flexor tenosynovitis of hand is frequently seen and is the closest differential. Non-specific clinical signs may lead to delay in diagnosis, which is often made after biopsy. Management includes surgical excision of necrotic tissue and infected synovium along with antitubercular therapy after histopathological diagnosis. MDR tuberculosis of hand is extremely rare and, to the best of our knowledge, has not been reported in the literature so far. We report an interesting case of MDR tubercular flexor tendon tenosynovitis of the little finger without any pulmonary involvement in an immunocompetent patient. The case was managed by complete synovectomy and second-line antitubercular therapy with complete resolution of disease and had no functional limitation.

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