scholarly journals A Case of Classic Raymond Syndrome

2012 ◽  
Vol 2012 ◽  
pp. 1-3
Author(s):  
Nicholas George Zaorsky ◽  
Jin Jun Luo
Keyword(s):  
Nerve Palsy ◽  
Brain Mri ◽  
Abducens Nerve ◽  
Acute Onset ◽  
Common Type ◽  
Facial Paresis ◽  
Clinical Observations ◽  
The Face ◽  
The Common ◽  
The Right

Classic Raymond syndrome consists of ipsilateral abducens impairment, contralateral central facial paresis, and contralateral hemiparesis. However, subsequent clinical observations argued on the presentation of facial involvement. To validate this entity, we present a case of classic Raymond syndrome with contralateral facial paresis. A 50 year-old man experienced acute onset of horizontal diplopia, left mouth drooling and left-sided weakness. Neurological examination showed he had right abducens nerve palsy, left-sided paresis of the lower part of the face and limbs, and left hyperreflexia. A brain MRI showed a subacute infarct in the right mid-pons. The findings were consistent with those of classic Raymond syndrome. To date, only a few cases of Raymond syndrome, commonly without facial involvement, have been reported. Our case is a validation of classic Raymond syndrome with contralateral facial paresis. We propose the concept of two types of Raymond syndrome: (1) the classic type, which may be produced by a lesion in the mid-pons involving the ipsilateral abducens fascicle and undecussated corticofacial and corticospinal fibers; and (2) the common type, which may be produced by a lesion involving the ipsilateral abducens fascicle and undecussated corticospinal fibers but sparing the corticofacial fibers.

scholarly journals The right eye abducens nerve palsy as a cranial neuropathy of dengue fever: The benefit of corticosteroids in an unusual dengue sequela

2019 ◽  
Vol 1 (2) ◽  
pp. 145-151
Author(s):  
Mohd Khairul Bin Abd Majid
Keyword(s):  
Dengue Fever ◽  
Nerve Palsy ◽  
Abducens Nerve ◽  
Acute Onset ◽  
Favourable Outcome ◽  
Abducens Nerve Palsy ◽  
Oral Steroid ◽  
Cranial Neuropathy ◽  
Systemic Corticosteroids ◽  
The Right

Dengue fever is very common in tropical climate countries and the number of reported cases in Malaysia shows an increasing trend recently, according to the Malaysian Clinical Practice Guidelines. Although dengue fever is common, cranial nerve mononeuropathy is a very rare manifestation in relation to other neurological-associated syndromes. We report a rare case of cranial mononeuropathy of dengue fever in Malaysia and highlight the option of steroid usage as an alternative treatment to hasten the neurological recovery. The patient, a 25-year-old healthy policeman, presented with symptomatic viral fever, which was serologically confirmed as dengue fever. He developed acute-onset binocular diplopia, which was secondary to right eye isolated abducens nerve palsy during the critical phase of dengue fever. His visual acuity was 6/6 in both eyes with slightly restricted abduction of the right eye, consistent with right abducens nerve palsy, which was confirmed with a Hess test. There was corresponding diplopia over the right paracentral visual field. Urgent contrasted brain imaging was done, which ruled out the life-threatening intracranial pathology; therefore, a diagnosis of possible subclinical inflammatory changes causing sixth nerve palsy was made. Subsequently, he was treated with intravenous methylprednisolone 500 mg daily for 3 days and regained full extraocular muscle movement after 1 week. Oral steroid was not initiated. In conclusion, although the isolated unilateral cranial mononeuropathy may improve spontaneously within a certain period of time, a short course of systemic corticosteroids may be considered to hasten the recovery, as it has a favourable outcome.

The Essence of Christianity and the Cross of Christ

1914 ◽  
Vol 7 (4) ◽  
pp. 538-594
Author(s):  
Benjamin B. Warfield
Keyword(s):  
New Haven ◽  
Liberal Theology ◽  
Religious System ◽  
The World ◽  
Cross Of Christ ◽  
The Face ◽  
Divinity School ◽  
The Common ◽  
The Cross ◽  
The Right

In a recent number of The Harvard Theological Review, Professor Douglas Clyde Macintosh of the Yale Divinity School outlines in a very interesting manner the religious system to which he gives his adherence. For “substance of doctrine” (to use a form of speech formerly quite familiar at New Haven) this religious system does not differ markedly from what is usually taught in the circles of the so-called “Liberal Theology.” Professor Macintosh has, however, his own way of construing and phrasing the common “Liberal” teaching; and his own way of construing and phrasing it presents a number of features which invite comment. It is tempting to turn aside to enumerate some of these, and perhaps to offer some remarks upon them. As we must make a selection, however, it seems best to confine ourselves to what appears on the face of it to be the most remarkable thing in Professor Macintosh's representations. This is his disposition to retain for his religious system the historical name of Christianity, although it utterly repudiates the cross of Christ, and in fact feels itself (in case of need) quite able to get along without even the person of Christ. A “new Christianity,” he is willing, to be sure, to allow that it is—a “new Christianity for which the world is waiting”; and as such he is perhaps something more than willing to separate it from what he varyingly speaks of as “the older Christianity,” “actual Christianity,” “historic Christianity,” “actual, historical Christianity.” He strenuously claims for it, nevertheless, the right to call itself by the name of “Christianity.”

Haemiballism/haemichorea: an atypical presentation of ischaemic stroke

2021 ◽  
Vol 14 (6) ◽  
pp. e240439
Author(s):  
Raman Nohria ◽  
Stacey Bennett ◽  
Yasmin Ali O'Keefe
Keyword(s):  
Brain Mri ◽  
Acute Onset ◽  
Cerebral Peduncle ◽  
Atypical Presentation ◽  
Cerebrospinal Fluid Analysis ◽  
Medication Therapy ◽  
Fluid Analysis ◽  
Ct Head ◽  
The Right ◽  
Distressing Condition

A 76-year-old man was admitted to the hospital with acute onset of involuntary movements of the left side of his body. His neurological examination revealed he was oriented only to himself, and aforementioned movements of his left arm and leg. CT head demonstrated old infarcts in his right aspect of his pons and basal ganglia. Cerebrospinal fluid analysis was unremarkable. He initially had a normal blood glucose with an elevated anion gap and elevated creatine kinase. Brain MRI showed a small lacunar-type ischaemic infarct within the anteromedial aspect of the right cerebral peduncle, which localised to his haemiballism. To prevent worsening rhabdomyolysis associated with his haemiballism, the primary team initiated both tetrabenazine and diazepam. His movements improved after 1 week of medication therapy. This report discusses a thorough workup for this movement disorder and when to intervene for this distressing condition.

scholarly journals Abducens Nerve Palsy as Initial Presentation of Multiple Myeloma and Intracranial Plasmacytoma

2018 ◽  
Vol 7 (9) ◽  
pp. 253
Author(s):  
Elochukwu Ibekwe ◽  
Neil Horsley ◽  
Lan Jiang ◽  
Nadine-Stella Achenjang ◽  
Azubuogu Anudu ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Multiple Myeloma ◽  
Nervous System ◽  
Case Report ◽  
Nerve Palsy ◽  
Abducens Nerve ◽  
Initial Presentation ◽  
Solitary Plasmacytoma ◽  
Cns Involvement ◽  
The Right

Central Nervous System (CNS) involvement in multiple myeloma and/or multifocal solitary plasmacytoma is rare. Although they are unique entities, multiple myeloma (MM) and plasmacytoma represent a spectrum of plasma cell neoplastic diseases that can sometimes occur concurrently. Plasmacytomas very often present as late-stage sequelae of MM. In this case report, we report a 53-year-old female presenting with right abducens cranial nerve (CN) VI palsy as an initial presentation secondary to lesion of the right clivus.

Pitfalls in Endovascular Treatment of Dural Arteriovenous Fistulas Involving the Cavernous Sinus

1997 ◽  
Vol 3 (2_suppl) ◽  
pp. 88-92
Author(s):  
N. Kuwayama ◽  
S. Endo ◽  
M. Kubo ◽  
T. Akai ◽  
A. Takaku
Keyword(s):  
Endovascular Treatment ◽  
Cavernous Sinus ◽  
Nerve Palsy ◽  
Transarterial Embolization ◽  
Abducens Nerve ◽  
Abducens Nerve Palsy ◽  
Arteriovenous Fistulas ◽  
Type D ◽  
Dural Arteriovenous Fistulas ◽  
The Right

Angiographic changes of the sylvian veins, superior ophthalmic vein (SOV), and superior petrosal sinus (SPS) before and after endovascular treatment were determined for 18 patients with dural arteriovenous fistulas (AVFs) involving the cavernous sinus, and pitfalls of endovascular treatment, especially regarding venous drainage routes, for 3 of the patients were reported. Case 1: 57-year-old woman who presented with right abducens nerve palsy had a Barrow type D fistula in the right cavernous sinus draining into the bilateral inferior petrosal sinuses (IPS). One of the ipsilateral sylvian veins that had drained antegradely before treatment was occluded, and a small lacunar infarction in the corona radiata developed after transvenous embolization (TVE) of the right cavernous sinus. Case 2: 72-year-old woman who presented with symptoms of right ocular hypertension had a type D fistula in the right cavernous sinus draining into only the ipsilateral SOV. Conjunctival hyperemia persisted and was aggravated after angioanatomical obliteration of the fistula by transarterial embolization. Case 3: 55-year-old man who presented with left abducens nerve palsy had a type D fistula in the left cavernous sinus draining into the ipsilateral IPS and sylvian vein. The dural AVF was obliterated once with TVE, but recurred 1 week later with retrograde drainage into the ipsilateral SPS and mesencephalic veins. A second TVE resulted in complete obliteration of the fistula. In conclusion, detailed analysis of drainage routes is necessary for planning of treatment of patients with dural AVF, and prompt treatment is needed when redistribution of drainage routes develops during or after TVE.

The Radical Right in Germany, Austria, and Switzerland

2018 ◽  
Author(s):  
Uwe Backes
Keyword(s):  
Party System ◽  
Common Ground ◽  
Civic Culture ◽  
Right Wing ◽  
Constitutional State ◽  
German Speaking ◽  
The Face ◽  
The Common ◽  
The Right ◽  
Special Case

This chapter analyzes and compares political developments in Germany, Austria, and Switzerland. It highlights the common ground between groups on the right-wing fringe of each country’s party system. To an extent the differences between the way right-wing groups developed in each of these countries is due to the different histories of the respective states. Recently however, they have moved closer to each other in the face of very similar problems. To a degree Switzerland is a special case because of its multilingual cantons and the early development of a pluralist civic culture that sustains an extraordinarily dynamic democratic constitutional state. This is particularly true given the autocratic relapses toward right-wing politics in neighboring German-speaking countries.

CELLULAR SCHWANNOMA OF THE GREATER SUPERFICIAL PETROSAL NERVE PRESENTING WITH ABDUCENS NERVE PALSY AND XEROPHTHALMIA

Neurosurgery ◽  
2008 ◽  
Vol 63 (4) ◽  
pp. E813-E814 ◽  
Author(s):  
Giyas Ayberk ◽  
Mehmet F. Ozveren ◽  
Nuket Uzum ◽  
Ozgur Tosun ◽  
Emine K. Akcay
Keyword(s):  
Nerve Palsy ◽  
Abducens Nerve ◽  
Abducens Nerve Palsy ◽  
Petrous Apex ◽  
Clinical Prognosis ◽  
Tear Secretion ◽  
Pathological Evaluation ◽  
Greater Superficial Petrosal Nerve ◽  
Extradural Approach ◽  
The Right

ABSTRACT OBJECTIVE Cellular schwannomas (CS) are rare in the cranial space. This report is the first of a patient with a greater superficial petrosal nerve CS presenting with abducens nerve palsy and xerophthalmia. CLINICAL PRESENTATION A 16-year-old female patient presented with a 1-month history of diplopia. Neurological examination was normal except for the presence of right abducens nerve palsy. Schirmer's test revealed decreased tear secretion in the right eye. Computed tomography and magnetic resonance imaging showed a mass in the right petrous apex. It was thought that the schwannoma in our patient originated from the greater superficial petrosal nerve, based on the location of the tumor in addition to the absence of partial Horner's syndrome and a persistent decrease in tear secretion. INTERVENTION: The tumor was exposed with the use of a right subtemporal extradural approach and removed entirely. Pathological evaluation of the tumor revealed a CS. CONCLUSION The abducens nerve palsy improved completely in the follow-up period, but the decreased tear secretion did not resolve. CS is one of the subtypes of ordinary schwannomas and exhibits malignant features on microscopic examination, although it has a good clinical prognosis. No adjuvant treatment was applied because of the tumor's benign character. The greater superficial petrosal nerve schwannoma should be considered in the differential diagnosis of the abducens nerve palsy and petrous apex mass.

scholarly journals Pituitary Apoplexy Presenting as Ophthalmoplegia and Altered Level of Consciousness without Headache

2018 ◽  
Vol 2018 ◽  
pp. 1-6
Author(s):  
Nooshin Salehi ◽  
Anthony Firek ◽  
Iqbal Munir
Keyword(s):  
Ct Scan ◽  
Cranial Nerve ◽  
Cranial Nerve Palsy ◽  
Nerve Palsy ◽  
Pituitary Apoplexy ◽  
Brain Magnetic Resonance Imaging ◽  
Acute Onset ◽  
Altered Level ◽  
Level Of Consciousness ◽  
The Right

Background. Pituitary apoplexy (PA) is a clinical syndrome caused by acute ischemic infarction or hemorrhage of the pituitary gland. The typical clinical presentation of PA includes acute onset of severe headache, visual disturbance, cranial nerve palsy, and altered level of consciousness. Case Report. A 78-year-old man presented to the emergency department with one-day history of ptosis and diplopia and an acute-onset episode of altered level of consciousness which was resolving. He denied having headache, nausea, or vomiting. Physical examination revealed third-cranial nerve palsy and fourth-cranial nerve palsy both on the right side. Noncontrast computed tomography (CT) scan of the head was unremarkable. Brain magnetic resonance imaging (MRI) showed a pituitary mass with hemorrhage (apoplexy) and extension to the right cavernous sinus. The patient developed another episode of altered level of consciousness in the hospital. Transsphenoidal resection of the tumor was done which resulted in complete recovery of the ophthalmoplegia and mental status. Conclusion. Pituitary apoplexy can present with ophthalmoplegia and altered level of consciousness without having headache, nausea, or vomiting. A CT scan of the head could be negative for hemorrhage. A high index of suspicion is needed for early diagnosis and timely management of pituitary apoplexy.

scholarly journals Persistent Autobiographical Amnesia: A Case Report

2007 ◽  
Vol 18 (1) ◽  
pp. 13-17 ◽  
Author(s):  
C. Repetto ◽  
R. Manenti ◽  
V. Sansone ◽  
M. Cotelli ◽  
D. Perani ◽  
...  
Keyword(s):  
Brain Mri ◽  
Motor Impairment ◽  
Acute Onset ◽  
Memory Deficit ◽  
Learning Abilities ◽  
Arterial Blood ◽  
Retrograde Memory ◽  
Global Amnesia ◽  
One Year ◽  
The Right

We describe a 47-year-old man who referred to the Emergency Department for sudden global amnesia and left mild motor impairment in the setting of increased arterial blood pressure. The acute episode resolved within 24 hours. Despite general recovery and the apparent transitory nature of the event, a persistent selective impairment in recollecting events from some specific topics of his personal life became apparent. Complete neuropsychological tests one week after the acute onset and 2 months later demonstrated a clear retrograde memory deficit contrasting with the preservation of anterograde memory and learning abilities. One year later, the autobiographic memory deficit was unmodified, except for what had been re-learnt. Brain MRI was normal while H20 brain PET scans demonstrated hypometabolism in the right globus pallidus and putamen after 2 weeks from onset, which was no longer present one year later. The absence of a clear pathomechanism underlying focal amnesia lead us to consider this case as an example of functional retrograde amnesia.

scholarly journals MON-701 Uncontrolled Diabetes Presenting as Isolated Sixth Nerve Palsy

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Paola Andrea Sanchez Garay ◽  
Rommel Zerpa ◽  
Gabriela Zuniga ◽  
Deyger Navarrete ◽  
Robert Lichtenberg
Keyword(s):  
Eicosapentaenoic Acid ◽  
Nerve Palsy ◽  
Acid Ethyl Ester ◽  
Abducens Nerve ◽  
Acute Onset ◽  
Abducens Nerve Palsy ◽  
Double Vision ◽  
Diagnostic Challenge ◽  
Sixth Nerve Palsy ◽  
Sixth Nerve

Abstract BACKGROUND Our case report demonstrates acute onset of diplopia due to Isolated Sixth Nerve Palsy (ISNP) secondary to uncontrolled T2DM, presenting as an ophthalmoplegia. The most frequent one, is ISNP with an incidence of 11.3/100.000 1. Vasculopathic ISNP is associated with atherosclerosis in patients older than 50 years 1. CASE PRESENTATION A 63 year-old male with history of T2DM, HTN, HL, came for evaluation of acute onset double vision 3 days prior. He noted diplopia while attempting to park his car; he saw that tracking to the left with his eyes would elicit double vision. Denied recent travel, trauma, headache or dizziness. He was awake and alert, BP 200/110mmHg, BMI 33. No pathologic murmur. He had PERRLA bilaterally but impaired lateral rectus muscle movement on the left side. Otherwise, EOMI on the right side. No facial asymmetry or ptosis. Overall, findings positive for ISNP. BMP only remarkable for a glucose of 297, HA1c was 10.0. Head CT was negative for any acute intracranial abnormality. Orbital MRI did not show acute infarction or masses. Patient was admitted for acute diplopia due to ISNP. Differential diagnoses were neoplasm, migraine, MS and diabetic neuropathy. Based on the aforementioned data, we suggested that T2DM was the probable cause. Counseling on improving glycemic control was given. Unfortunately, patient was lost to follow up. DISCUSSION ISNP remains an elusive entity; atherosclerotic risk factors such as DM, HTN, HL, hyperhomocysteinemia 2 or viral infections 3 have been reported in association. This type of palsy seems to be more frequent in children and can be recurrent in nature. In adults, the most likely cause of ISNP seems to be ischemic mononeuropathy or more aggressive etiologies such as temporal arteritis 4. Inconclusive images prove even a higher diagnostic challenge 3. Of note, we found a case demonstrating evidence for Eicosapentaenoic Acid in the improvement of ISNP with recovery in as shortly as 8 weeks. The basis of this treatment lies in the recovery of endothelial function focusing on the anti-platelet and anti-inflammatory effects of the drug2,4. REFERENCES (1). Elder, Christopher, et al. “Isolated abducens nerve palsy: update on evaluation and diagnosis.” Current neurology and neuroscience reports 16.8 (2016): 69. (2). Takenouchi, Yasuhiro, et al. “Eicosapentaenoic acid ethyl ester improves endothelial dysfunction in type 2 diabetic mice.” Lipids in health and disease 17.1 (2018): 118. (3). Azarmina, Mohsen, and Hossein Azarmina. “The six syndromes of the sixth cranial nerve.” Journal of ophthalmic & vision research 8.2 (2013): 160. (4). Yanai, Hidekatsu, and Mariko Hakoshima. “Eicosapentaenoic Acid for Diabetic Abducens Nerve Palsy.” Journal of Endocrinology and Metabolism 7.4 (2017): 131–132.

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