Wall eyed bilateral internuclear ophthalmoplegia (WEBINO) syndrome as a false localising sign in intracranial haemorrhage due to snake bite

2021 ◽  
Vol 14 (9) ◽  
pp. e244830
Author(s):  
Shruti Sinha ◽  
Bhaimangesh Bhanudas Naik ◽  
Jaishree Ghanekar
Keyword(s):  
Brain Stem ◽  
Demyelinating Disease ◽  
Clinical Signs ◽  
Sudden Onset ◽  
Snake Bite ◽  
Internuclear Ophthalmoplegia ◽  
Ocular Motor ◽  
Common Causes ◽  
Unidentified Species ◽  
Clinical Description

A 48-year-old woman presented with sudden-onset altered sensorium 2 days after a snake bite (unidentified species) and was found to have a large right frontal intracerebral haemorrhage (ICH) with transtentorial herniation (TTH) causing brain stem compression. A day later, neurological examination revealed internuclear ophthalmoplegia (INO) fitting the clinical description of wall eyed bilateral INO syndrome. INO is a rare ocular motor sign, the most common causes being brain stem infarction, haemorrhage or demyelinating disease. It rarely acts as a false localising sign, such as in this case, and in an even rarer cause for ICH, that is, haemotoxic snake bite without initial evidence of coagulopathy. An emphasis needs to be laid on detailed physical examination, often considered a lost art nowadays, to help detect subtle clinical signs which could herald ominous complications of conditions like TTH and help in early diagnosis and treatment of the same.

Internuclear ophthalmoplegia following head injury

1979 ◽  
Vol 51 (4) ◽  
pp. 552-555 ◽  
Author(s):  
Robert S. Baker
Keyword(s):  
Multiple Sclerosis ◽  
Brain Stem ◽  
Head Trauma ◽  
Internuclear Ophthalmoplegia ◽  
Ocular Abnormalities ◽  
Content Type ◽  
Arnold Chiari Malformation ◽  
Common Causes ◽  
The Brain ◽  
Fine Print

✓ The most common causes of internuclear ophthalmoplegia (INO) are multiple sclerosis and vascular disease of the brain stem. Rarer causes are tumor, Arnold-Chiari malformation, and syphilis. Myasthenia gravis has, on occasion, presented with ocular abnormalities indistinguishable from INO. A case is described of bilateral INO of brief duration following head trauma. There were no other brain-stem abnormalities. This brings to 11 the number of reported patients in whom head trauma precipitated this abnormality.

scholarly journals Clinical Presentation of Preterm Neonates with Intraventricular Hemorrhage: Experience in a Tertiary Care Hospital in Dhaka

2017 ◽  
Vol 7 (3) ◽  
pp. 194-197
Author(s):  
Tasnima Ahmed ◽  
Abdul Baki ◽  
Tahmina Begum ◽  
Nazmun Nahar
Keyword(s):  
Clinical Features ◽  
Intraventricular Hemorrhage ◽  
Tertiary Care ◽  
Clinical Signs ◽  
Sudden Onset ◽  
Morbidity And Mortality ◽  
Preterm Neonates ◽  
Cranial Ultrasound ◽  
Care Hospital ◽  
One Year

Background: Intraventricular hemorrhage (IVH) is common among preterm infants as many of them survive with the advancements in neonatal care. Severe IVH may lead to significant morbidity and mortality. The objective of our study is to find out the significant clinical signs of IVH in preterm neonate for early detection by ultrasonography.Methods: This prospective observational study was done in special care baby unit (SCABU), Bangladesh Institute of Research & rehabilitation of Diabetic, Endocrine & metabolic Disorder (BIRDEM) for a period of one year. Eighty five preterm neonates were included in this study. Clinical features of IVH like- convulsion, lethargy, irritability, bulged fontanelle, recurrent apnea, sudden onset of respiratory distress, sudden pallor and bradycardia were observed. Cranial ultrasound studies were done within 7 days of life in all cases to identify IVH.Result: Mean gestational age of these neonates was 31.31(±2.2) weeks & mean birth weight was 1413.42 (±330.55) gm. Among 85 preterm neonates 21(24.7%) developed IVH, confirmed by ultrasonography of brain. Clinical features like convulsion, bulged fontanel, repeated apnea & sudden pallor were significantly present in IVH group.Conclusion: Intraventricular Hemorrhage constitutes an important cause of morbidity and mortality in neonate. This study showed that clinical features like convulsion, bulged fontanel and sudden pallor had a significant relationship with intraventricular hemorrhage which will help for its early detection.Birdem Med J 2017; 7(3): 194-197

scholarly journals Saccadic Alterations in Severe Developmental Dyslexia

2013 ◽  
Vol 2013 ◽  
pp. 1-5
Author(s):  
Stefano Pensiero ◽  
Agostino Accardo ◽  
Paola Michieletto ◽  
Paolo Brambilla
Keyword(s):  
Information Processing ◽  
Visual Evoked Potentials ◽  
Developmental Dyslexia ◽  
Visual Information ◽  
Motor Deficits ◽  
Internuclear Ophthalmoplegia ◽  
Saccadic Eye Movement ◽  
Ocular Motor ◽  
Pattern Visual Evoked Potentials ◽  
Rapid Visual Information Processing

It is not sure if persons with dyslexia have ocular motor deficits in addition to their deficits in rapid visual information processing. A 15-year-old boy afflicted by severe dyslexia was submitted to saccadic eye movement recording. Neurological and ophthalmic examinations were normal apart from the presence of an esophoria for near and slightly longer latencies of pattern visual evoked potentials. Subclinical saccadic alterations were present, which could be at the basis of the reading pathology: (1) low velocities (and larger durations) of the adducting saccades of the left eye with undershooting and long-lasting postsaccadic onward drift, typical of the internuclear ophthalmoplegia; (2) saccades interrupted in mid-flight and fixation instability, which are present in cases of brainstem premotor disturbances.

scholarly journals The induced dose of experimental autoimmune encephalomyelitis was not determinant and proportional to histopathological findings

2021 ◽  
Vol 31 (Supplement_2) ◽  
Author(s):  
Maiara Carolina Perussolo ◽  
Bassam Felipe Mogharbel ◽  
Lucia de Noronha ◽  
Katherine Athayde Teixeira de Carvalho
Keyword(s):  
Spinal Cord ◽  
Experimental Autoimmune Encephalomyelitis ◽  
Demyelinating Disease ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Control Group ◽  
Autoimmune Encephalomyelitis ◽  
Histopathological Findings ◽  
The Brain ◽  
Experimental Autoimmune

Abstract Background Multiple sclerosis (MS) is an autoimmune disease of the central nervous system, characterized as an inflammatory demyelinating disease. It presents a diversity of neurologic signs and symptoms as well the incapacities. Since the need for advances in MS treatment, many studies are for new therapeutic technologies, mainly through using preclinical models as experimental autoimmune encephalomyelitis (EAE). This study aimed to observe and analyze the development in Lewis rats-induced model of EAE. Methods It was used 23 females of Rattus norvegicus, from 6 to 8 weeks, weighing around 170 g. Of 23 rats, 19 underwent EAE induction distributed in six groups to establish the evolution of clinical signs. B. pertussis toxin (PTX) doses were 200, 250, 300, 350–400 ng, and four animals as the control group. The animals had weight and scores analyzed daily, starting seven and ending 24 days after induction. Then, all animals were euthanized, and the brain and spinal cord were collected for histopathological analyses. Results The results showed that the dose of 250 ng of PTX induced de higher score and weight reduction. All groups who received the PTX demonstrated histopathological findings. Those characterized as leukocyte infiltration, activation of microglia and astrocytes, and demyelinated plaques in the brain. In the spinal cord, the loosening of the myelinated fibers was observed by increasing the axonal space in all tested doses of PTX. Conclusions EAE was not dose-dependent. Histopathological findings do not proportionally related to clinical signs, as in human patients with MS.

scholarly journals Highly Variable Clinical Pictures in Dogs Naturally Infected with Angiostrongylus vasorum

Pathogens ◽  
2021 ◽  
Vol 10 (11) ◽  
pp. 1372
Author(s):  
Mariasole Colombo ◽  
Donato Traversa ◽  
Eleonora Grillotti ◽  
Carlo Pezzuto ◽  
Cesare De Tommaso ◽  
...  
Keyword(s):  
Southern Italy ◽  
Clinical Signs ◽  
Sudden Onset ◽  
High Variability ◽  
Angiostrongylus Vasorum ◽  
Coagulation Disorders ◽  
Life Threatening ◽  
Healthy Dogs ◽  
Clinical Pictures ◽  
Apparently Healthy

Canine angiostrongylosis by Angiostrongylus vasorum is increasingly reported in both enzootic and previously free areas. The complex pathogenesis of the disease makes the clinical workup challenging. Infected dogs show highly variable clinical pictures, characterized by subclinical to life-threatening general, cardio-respiratory, neurological and/or gastrointestinal signs. The present study reports the high variability of clinical pictures from 36 dogs across central and southern Italy that were naturally infected by A. vasorum. Of them, 23 (63.9%) presented at least one clinical sign, while 13 (36.1%) were subclinically infected and apparently healthy. Overall, 19 dogs (52.8%) showed cardiorespiratory signs, 14 (38.9%) had non-specific abnormalities, 2 (5.6%) presented coagulation disorders and 1 (2.8%) had a severe neurological condition. Importantly, four dogs presenting with clinical signs had neither cough nor dyspnea. These results underline that angiostrongylosis should be included in the differential diagnosis, even when dogs display only non-specific clinical signs. The proportion of apparently healthy dogs highlights the relevance of routine copromicroscopic and/or antigenic tests in enzootic areas to avoid the sudden onset of potentially life-threatening signs.

Fourth Nerve Palsy

2019 ◽  
pp. 105-110
Author(s):  
Matthew J. Thurtell ◽  
Robert L. Tomsak
Keyword(s):  
Nerve Palsy ◽  
Clinical Signs ◽  
Strabismus Surgery ◽  
Step Test ◽  
Management Options ◽  
Common Cause ◽  
Common Causes ◽  
The Common ◽  
Skew Deviation ◽  
Fourth Nerve Palsy

Fourth nerve palsy is a common cause of binocular vertical diplopia. However, it can be difficult to diagnose because the clinical signs are often subtle. In this chapter, we begin by reviewing the symptoms of fourth nerve palsy. We next discuss clinical maneuvers for diagnosing fourth nerve palsy, including the Parks-Bielschowsky three-step test. We list the common causes for isolated fourth nerve palsy and review its differential diagnosis, which includes skew deviation and myasthenia gravis. We then discuss the indications for neuroimaging in a patient with fourth nerve palsy. Lastly, we discuss management options for fourth nerve palsy, which include prisms and strabismus surgery.

Rapidly Progressive Dementia and Coma

2019 ◽  
pp. 704-712
Author(s):  
Prasuna Kamireddi ◽  
Jason L. Siegel ◽  
Dennis W. Dickson
Keyword(s):  
Intensive Care Unit ◽  
Functional Ability ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Cognitive Domain ◽  
Progressive Dementia ◽  
Common Causes ◽  
Jakob Disease ◽  
Clinical Signs And Symptoms ◽  
Definition Of

In most patients with dementia, the clinical signs and symptoms progress gradually over many years. However, neurointensivists may encounter patients who have rapidly progressive dementia (RPD). Often these patients need to be admitted to the intensive care unit for management of status epilepticus, agitation, or ventilation in coma. Although the prototype of RPD is Creutzfeldt-Jakob disease, this chapter reviews other common causes of RPD. An established definition of RPD does not exist, but in this chapter RPD refers to the loss of more than 1 cognitive domain and functional ability, usually occurring over a few months.

Compressive Optic Neuropathy

2011 ◽  
pp. 21-24
Author(s):  
Matthew J. Thurtell ◽  
Robert L. Tomsak ◽  
Robert B. Daroff
Keyword(s):  
Optic Nerve ◽  
Optic Neuropathy ◽  
Vision Loss ◽  
Clinical Signs ◽  
Monocular Vision ◽  
Compressive Optic Neuropathy ◽  
Imaging Characteristics ◽  
Optic Nerve Sheath Meningioma ◽  
Common Causes ◽  
Optic Nerve Compression

Optic nerve compression results in progressive, and often painless, monocular vision loss. In this chapter, we review the clinical signs and common causes of compressive optic neuropathy. We discuss in more detail the imaging characteristics and management of optic nerve sheath meningioma.

Clinical Signs with Modified Electroconvulsive Therapy

1963 ◽  
Vol 109 (460) ◽  
pp. 399-403 ◽  
Author(s):  
J. G. Whitwam ◽  
T. Moreton ◽  
J. Norman
Keyword(s):  
Electroconvulsive Therapy ◽  
Muscle Relaxant ◽  
Parasympathetic Nervous System ◽  
Clinical Signs ◽  
Short Acting ◽  
Neurological Signs ◽  
Clinical Description ◽  
Modified Electroconvulsive Therapy ◽  
Acting Muscle ◽  
Stimulation Of

In many electroconvulsive therapy centres atropine is used to mitigate adverse effects resulting from stimulation of the parasympathetic nervous system, while the violence of muscular contractions is controlled with a muscle relaxant. It is customary to secure hypnosis with a short acting barbiturate prior to administration of the relaxant. The first report of the use of thiopentone for E.C.T. was by Rubinstein (1945), and methohexitone (Lilly 25398) was introduced by Friedman (1959). The use of succinylcholine (iodide) for E.C.T. was first reported by Holmberg and Thesleff (1951). The neurological signs during unmodified E.C.T. have been well documented (e.g. Klein and Early, 1948a, 1948b, 1949; Kalinowsky and Hoch, 1952). There is as yet no comparable detailed clinical description of E.C.T. when modified by atropine and a short acting muscle relaxant preceded by a barbiturate. This discussion is limited to some of those signs which may be of assistance in the management of therapy.

Terapia fibrinolitica intra-arteriosa in occlusione vertebrobasilare acuta

1997 ◽  
Vol 10 (2_suppl) ◽  
pp. 207-210
Author(s):  
S. Mangiafico ◽  
G. Villa ◽  
G.P. Giordano ◽  
V. Scardigli ◽  
C. Pandolfo ◽  
...  
Keyword(s):  
Brain Stem ◽  
Clinical Signs ◽  
Fibrinolytic Therapy ◽  
Artery Occlusion ◽  
Acute Onset ◽  
Basilar Artery Occlusion ◽  
Cerebral Stroke ◽  
Clinical Onset ◽  
Vertebrobasilar Stroke ◽  
Basilar Occlusion

Intra-arterial fibrinolytic therapy in acute vertebrobasilar occlusion is effective in saving the patient's life in 75% of cases if performed within 6 hours after the beginning of an ischemic event, without CT evidence of hypodense focal areas in the brain stem, cerebellum or thalamic nucleus. The initial clinical aspect of vertebrobasilar stroke is more often evolving. Only in 1/3 of cases is coma present at the beginning. In vertebro-basilar occlusion prognosis is determined by clinical and neuroradiological aspects. The outcome depends mainly upon how much brain stem function is lost during the reperfusion time, and the kind of vertebrobasilar occlusion. The case we present concerns a 38 year old man with acute onset of cerebral stroke without initial clinical signs of vertebrobasilar localization due to a basilar artery occlusion distal to AICA. Urokinase infusion was performed within three hours from the clinical onset up to a total amount of 1.400.000 UI. Reperfusion was observed one hour after the beginning of the intravascular therapy. The clinical course was favorable with good recovery (moderate superior right paresis, controlateral light cerebellar syndrome).

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