Levator palpabrae superioris myositis as an unusual cause of unilateral ptosis—case report

Abstract Background Ptosis can be a manifestation of a more serious situation. Hence, the analysis of the complaint and the search for etiology are crucial in such cases. Ptosis has many causes; some of them lead to unilateral ptosis while others cause bilateral ptosis. For instance, myasthenia gravis is a cause of bilateral ptosis while oculomotor nerve palsy induces unilateral disease. Proper evaluation of the patient and identification of the cause are important to achieve accurate management and good prognosis. Case presentation A 47-year-old male patient attended the ER complaining of dropping the right eye lid of 2 days’ duration. There was no associated pain or diplopia. On examination, the extraocular muscles’ (EOM) motility was intact, normal pupil and corneal reflexes, and there was swelling of the upper eyelid. Ophthalmological examination revealed normal anterior and posterior chambers as well as the vitreous and retina. The patient had a previous history of traumatic intracranial hemorrhage that was resolved without surgical intervention. He also had diabetes mellitus and hypertension. The patient was transferred to the MRI unit to perform MRI study of the brain and orbit with MRA and IV contrast administration. MRI findings confirmed the diagnosis of LPS myositis, and the patient received medical treatment and improved. Conclusion Proper radiological diagnosis leads to accurate management and achieves rapid recovery and optimal patient care.

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Anxiety Disorder and Alternating Bilateral Ptosis as the First Symptoms of Diabetes: A Case Report

10.31487/j.crss.2020.01.07 ◽

2020 ◽

pp. 1-3

Author(s):

Song Wang ◽

Mei-lan Su ◽

Ming-hong Zhang ◽

Song Wang ◽

Zhong-Hui Zou ◽

...

Keyword(s):

Case Report ◽

Anxiety Disorder ◽

Nerve Palsy ◽

Blood Glucose Control ◽

Oculomotor Nerve ◽

Oculomotor Nerve Palsy ◽

Comprehensive Treatment ◽

Bilateral Ptosis ◽

Upper Eyelid

Introduction: Long-term diabetes may cause oculomotor nerve palsy and anxiety disorder. Diabetic oculomotor nerve palsy is usually accompanied by diplopia, ptosis and eye movement disorders. The oculomotor nerve is often separated into superior and inferior divisions; diabetic third cranial nerve palsy may affect either division in isolation. However, anxiety disorder and alternating bilateral ptosis as the first symptoms of diabetes are extremely rare. Case Presentation: This case report describes a 63-year-old female patient who was admitted to the hospital for anxiety disorder with bilateral alternating ptosis. The patient had no diplopia or other new focal neurological symptoms. A neurological examination revealed left upper eyelid ptosis; other findings were negative. Except for hyperglycemia (13.96 mmol/L) and glycated hemoglobin (7.9%), laboratory tests showed no other abnormalities. The patient eventually recovered in a short time after a comprehensive treatment, including effective blood glucose control, microcirculation improvement and anxiety management. Conclusion: The upper eyelid droop caused by long-term diabetes may result in anxiety disorder. A comprehensive treatment may be considered for the patients admitted to the hospital for diabetes and its vascular neuropathy.

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Work ability evaluation in neurosarcoidosis: A case report

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh0606238m ◽

2006 ◽

Vol 134 (5-6) ◽

pp. 238-240

Author(s):

Aleksandar Milovanovic ◽

Jovica Milovanovic ◽

Nikola Torbica

Keyword(s):

Case Report ◽

Unknown Etiology ◽

Ophthalmological Examination ◽

Resonance Imaging ◽

Working Ability ◽

Bilateral Ptosis ◽

Focal Lesions ◽

Initial Manifestation ◽

The Central Nervous System ◽

The Right

Sarcoidosis is a multisystemic granulomatous disease of unknown etiology which affects most frequently the hilar lymph nodes and lungs. Symptomatic involvement of the central nervous system may develop in patients diagnosed with sarcoidosis or it may be the initial manifestation of the disease. This is a case report of 48-year old female patient admitted to our clinic for evaluation of working ability. The patient had a total of 24 years of service and occupational exposure and she has been employed as supplies procurement officer. On admission, she complained of the following discomforts: eye-lid pain, intellectual fatigue, psychic uneasiness, forgetfulness, dyspnea and productive cough. Neurological findings indicated the presence of the right eye ophthalmoplegia, psychoorganic syndrome and neurosarcoidosis. Ophthalmological examination evidenced bilateral ptosis and presence of anisocoria. Magnetic resonance imaging revealed discrete focal lesions of the pons (paracentral left) and parietal corona radiata of the left hemisphere. Based on performed examinations and diagnostics procedures, final evaluation of patient?s working ability concluded that the patient was not capable of psychic strains and jobs associated with material accountability.

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Abstract WMP59: Multiple Scattered Tiny Cerebral Infarctions Are Unlikely Cardiogenic

Stroke ◽

10.1161/str.47.suppl_1.wmp59 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Yi Dong ◽

Yuan Gao ◽

Deepak S Nair ◽

Sarah Parker ◽

Jan L Jahnel ◽

...

Keyword(s):

Oral Anticoagulants ◽

Previous History ◽

B Cell Lymphoma ◽

Median Number ◽

Mri Imaging ◽

Mri Findings ◽

Presenting Symptoms ◽

Recurrent Strokes ◽

Moderate Chronic Kidney Disease ◽

The Right

Background: Embolic ischemic strokes are commonly considered to be cardiogenic. In clinical practice, however,patients with a pattern of multiple tiny ischemic foci on MRI often have no cardiac source. To identifying its etiology may help selecting the right therapy to treat or prevent recurrent strokes. Methods: From 1/2010 to 12/2013, records and MRI imaging of 2984 consecutive stroke patients were reviewed. Patients with the following DWI MRI findings were included: 1) ≥3 high intensity lesions in three different arterial territories, 2) each ≤15mm in size and ≤2 sections in thickness. Other data reviewed include general demographics, clinical features and lab results. Patients with known cardiac embolism, aortic arch plaques or aneurysms and recent surgery were excluded. Images of follow-up MRI were reviewed. Results: Among 2984 cases reviewed, 71 patients had multiple tiny DWI lesions. In order to rule out artery to artery emboli, patients with lesions from the same artery territory or watershed region were excluded. Only 43 met all criteria. Their median age was 65 and 23(53.5%) were male. Extremity weakness and slurred speech were the most common presenting symptoms. The median number of DWI lesions in each brain was 13. Common disorders identified include: infection (81.4%), hyperlipidemia(58.1%), moderate chronic kidney disease(39.5%), previous history of stroke (48.8%). Four (9.3%) had large B cell lymphoma and 2 had lung cancer. The quantity of DWI lesions was related to hyperglycemia, hyperlipidemia and impaired GFR. Patients with primary hypercoagulable state more likely had multiple lesions (median 39). On discharge, 5 (11.6%) patients were prescribed dual antiplatelet therapy and 11 (25.6%) were given oral anticoagulants. Conclusions: To our knowledge, this was the first review of this type of specific DWI findings with clinical correlation. Multiple tiny or ‘Star-like’ type of lesions on DWI MRI were likely caused by infection, hyperlipidemia CKD and leukemia. They are unlikely cardiogenic and its recurrent rate was high. Recognizing the pattern of these tiny lesions will help clinicians refocus on the work up of stroke, strategies of treatment and stroke prevention strategy.

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Traumatic perforations of tympanic membrane: our experience

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20185300 ◽

2018 ◽

Vol 5 (1) ◽

pp. 131

Author(s):

Anuja Bhargava ◽

Syed M. Faiz ◽

Mohammad Shakeel ◽

Nafas J. Singh ◽

Kumar Gaurav

Keyword(s):

Domestic Violence ◽

Middle Ear ◽

Clinical Presentation ◽

Previous History ◽

Good Prognosis ◽

Common Etiology ◽

History Of ◽

The Right ◽

Inferior Quadrant ◽

Pathology Data

Background: The aim of the study was to evaluate various etiological factors, clinical presentation in patients presenting with Traumatic ear perforations.Methods: 27 patients were taken in our study who reported within two weeks of history of trauma with no previous history of middle ear pathology. Data was collected and patients were treated. Results: 27 patients were studied (11 males and 16 females); age ranging from 15 years to 56 years. Laterality of trauma was found to be more in left ear. Aural Fullness & pain in ear were the most common presenting complaints. Most common etiology was found to be assault and poster inferior quadrant was found to be most commonly involved.Conclusions: Traumatic perforations have a very good prognosis if they are treated at the right time. We would also like to stress on the fact that domestic violence is still prevalent in our society leading to patients of traumatic perforation.

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Cerebral Infarction Associated With Thrombosed Developmental Venous Anomaly: A Case Report

Advances in Bioscience and Clinical Medicine ◽

10.7575/aiac.abcmed.ca1.14 ◽

2017 ◽

pp. 14

Author(s):

Mehdi Karimian ◽

Afshin Borhani Haghighi

Keyword(s):

Protein C ◽

Rare Complication ◽

Brain Infarction ◽

Cranial Nerves ◽

Previous History ◽

Central Vein ◽

Developmental Venous Anomaly ◽

Venous Anomaly ◽

Mri Findings ◽

The Right

Introduction:Developmental venous anomaly (DVA, venous angioma) is a congenital vascular variant of cerebral venous drainage, which consists of several radial veins draining into an enlarged central vein (caput medusa appearance). This anatomical variations are usually followed by benign and asymptomatic clinical course, so it is incidentally detected at MRI, MRA, CT, angiography or autopsy performed for unrelated problems. Rarely DVAs become symptomatic and present with headache, seizures, numbness, diplopia, paresthesia, syncope and focal neurologic deficit secondary to thrombosis in drainage veins. Hemorrhagic complications occur more often than isolated ischemic events. Also, non-hemorrhagic brain infarction is a rare complication in these patients. We describe a patient with non-hemorrhagic venous infarction associated with DVA.Case report:A 57-year- old female patient was admitted to Namazi hospital with complaints of acute severe headache in the right temporo-occipital region, vertigo, left sided paresthesia and weakness. She was in good health a week prior to admission when the blurred vision appeared in her right eye. The patient had previous history of recurrent episodes of migraine-like headache that controlled by medical therapy. The family history was unremarkable. Her only medications were various oral contraceptives and propranolol. On examination, she was afebrile and alert with stable vital signs. Her pupils were equal and reactive to light. Neurological examination was normal and the cranial nerves were intact. The deep tendon reflexes were brisk and symmetric and bilateral Babinski and Hoffmann’s signs were present. On admission, her speech, memory, and intellectual performance were normal. She had weakness of the upper and lower extremities (especially on the left side) and her knees were unstable while walking. Hematology and coagulation tests (protein C, activated protein C resistance, protein S, homocysteine, anticardiolipin antibodies, antithrombin III and antinuclear anti body) were normal.The initial CT scan of the brain demonstrated no evidence of abnormal density, hydrocephalus or hemorrhagic process in the cerebral hemispheres, MRI findings revealed several radially arranged veins converging to a small enlarged vein in the right temporo-occipital lobe. Thrombosis of collector veins detected as a hypersignality on contrast enhanced MRI. Also, “caput medusa” configuration was detectable in angiography.

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Surgical therapy for herlyn-werner-wunderlich (HWW) syndrome cases

International Journal of Family & Community Medicine ◽

10.15406/ijfcm.2021.05.00238 ◽

2021 ◽

Vol 5 (5) ◽

pp. 152-156

Author(s):

Pangastuti N ◽

Rahman MN ◽

Setyawan N

Keyword(s):

Sigmoid Colon ◽

Surgical Therapy ◽

Previous History ◽

Clinical Manifestations ◽

Good Prognosis ◽

Menstrual Blood ◽

Vaginal Agenesis ◽

Main Complaint ◽

First Case ◽

The Right

Introduction: One of the rare forms of Mullerian congenital ducts is Herlyn-Werner-Wunderlich (HWW) syndrome. HWW syndrome is usually found at puberty with nonspecific symptoms. Pelvic pain can be found both acute and chronic, dysmenorrhoea, as well as hematometra and hematocolpos. Early detection and treatment results in a good prognosis with fertility preservation. Case presentation: Two cases of Herlyn-Werner-Wunderlich (HWW) syndrome surgically performed were reported at Dr. Sardjito Yogyakarta Indonesia Central General Hospital in 2017-2018. Both cases are still children and at the age of puberty. The chief complaint in both cases it was reported to have the same main complaint, abdominal pain, with the condition having never experienced menstruation yet. On further examination it is known that pain is caused due to hematometra and hematosalping that occur in both cases. The first case with hematometra in the right hemiuterus and right hematosalpinx, while second case with hematometra in the uterus didelphys and bilateral hematosalpinx. One case with a normal vagina, and the other case of vaginal agenesis. There was previous history of surgery in both of cases. There are abnormalities in the urinary tract that occur together with these genital abnormalities. Surgical therapy is carried out with the main goal being to drain menstrual blood from hematometra and hematosalpinx. In first case which has a vagina within the normal range (9 cm long) and the inferior area of the right hemiuterus which is bulging toward the vagina, an area can be identified for the drainage incision to drain the entire hematometra and hematosalpinx. In the second case with vaginal agenesis, neovagina which is made by sigmoid colon vaginoplasty surgery can be a way of menstrual blood flow for a lifetime. Conclusion: Clinical manifestations of Herlyn-Werner-Wunderlich (HWW) syndrome cases can be classified into 2 groups, complete and incomplete. Surgical treatment is based on the condition of the uterus and vagina. In the condition of cervical agenesis but with a normal vagina, surgery can be done by making an incision in the drainage of the uterine cervical tissue. If vaginal agenesis is obtained, vaginoplasty surgery can be performed, and one of the options is sigmoid colon vaginoplasty.

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Popliteal artery thrombosis secondary to a tibial osteochondroma

VASA ◽

10.1024/0301-1526/a000101 ◽

2011 ◽

Vol 40 (3) ◽

pp. 251-255 ◽

Cited By ~ 4

Author(s):

Gruber-Szydlo ◽

Poreba ◽

Belowska-Bien ◽

Derkacz ◽

Badowski ◽

...

Keyword(s):

Case Report ◽

Magnetic Resonance Angiography ◽

Popliteal Artery ◽

Doppler Ultrasonography ◽

Histopathological Examination ◽

Previous History ◽

Plain Radiography ◽

Artery Thrombosis ◽

History Of ◽

The Right

Popliteal artery thrombosis may present as a complication of an osteochondroma located in the vicinity of the knee joint. This is a case report of a 26-year-old man with symptoms of the right lower extremity ischaemia without a previous history of vascular disease or trauma. Plain radiography, magnetic resonance angiography and Doppler ultrasonography documented the presence of an osteochondrous structure of the proximal tibial metaphysis, which displaced and compressed the popliteal artery, causing its occlusion due to intraluminal thrombosis..The patient was operated and histopathological examination confirmed the diagnosis of osteochondroma.

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Left suboccipital supracerebellar transtentorial approach for resection of tectal cavernous malformation

Neurosurgical Focus: Video ◽

10.3171/2019.10.focusvid.19394 ◽

2019 ◽

Vol 1 (2) ◽

pp. V19

Author(s):

Hussam Abou-Al-Shaar ◽

Timothy G. White ◽

Ivo Peto ◽

Amir R. Dehdashti

Keyword(s):

Nerve Palsy ◽

Oculomotor Nerve ◽

Oculomotor Nerve Palsy ◽

Entry Zone ◽

Third Nerve Palsy ◽

History Of ◽

Tectal Plate ◽

The Right ◽

Transtentorial Approach ◽

Third Nerve

A 64-year-old man with a midbrain cavernoma and prior bleeding presented with a 1-week history of diplopia, partial left oculomotor nerve palsy, and worsening dysmetria and right-sided weakness. MRI revealed a hemorrhagic left tectal plate and midbrain cavernoma. A left suboccipital supracerebellar transtentorial approach in the sitting position was performed for resection of his lesion utilizing the lateral mesencephalic sulcus safe entry zone. Postoperatively, he developed a partial right oculomotor nerve palsy; imaging depicted complete resection of the cavernoma. He recovered from the right third nerve palsy, weakness, and dysmetria, with significant improvement of his partial left third nerve palsy.The video can be found here: https://youtu.be/ofj8zFWNUGU.

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Neuroimaging of Children With Takayasu Arteritis

Journal of Child Neurology ◽

10.1177/0883073821991287 ◽

2021 ◽

pp. 088307382199128

Author(s):

Hafize Emine Sönmez ◽

Ferhat Demir ◽

Semanur Özdel ◽

Şerife Gül Karadağ ◽

Esra Bağlan ◽

...

Keyword(s):

Takayasu Arteritis ◽

Internal Carotid ◽

Laboratory Data ◽

Left Middle Cerebral Artery ◽

Mri Findings ◽

Cranial Mri ◽

Magnetic Resonance Imaging Mri ◽

The Right ◽

And Diffusion ◽

Left Middle

Objective: Takayasu arteritis is a rare granulomatous chronic vasculitis that affects the aorta and its main branches. Neurologic manifestations can accompany the disease; however, there is no study on neuroimaging in children with Takayasu arteritis. Therefore, we aimed to evaluate cranial magnetic resonance imaging (MRI) in pediatric Takayasu arteritis patients. Materials and Methods: Demographic, clinical, and laboratory data were obtained retrospectively. Results: The study included 15 pediatric Takayasu arteritis patients. All patients presented with constitutional symptoms. Additionally, 6 patients suffered from headache, 2 had syncope, 1 had loss of consciousness, and 1 had convulsion. All patients underwent cranial and diffusion MRI a median 12 months after diagnosis. Cranial MRI findings were normal in 12 patients, whereas 3 patients had abnormal findings, as follows: stenosis in the M1 and M2 segments of the left middle cerebral artery (n = 1); diffuse thinning of the right internal carotid, middle cerebral, and right vertebral and basilar artery (n = 1); as a sequela, areas of focal gliosis in both the lateral ventricular and posterior periventricular regions (n = 1). Among these 3 patients, 1 had no neurologic complaints. Conclusion: Abnormal MRI findings can be observed in pediatric Takayasu arteritis patients, even those that are asymptomatic; therefore, clinicians should carefully evaluate neurologic involvement in all pediatric Takayasu arteritis patients.

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Neural alignment predicts learning outcomes in students taking an introduction to computer science course

Nature Communications ◽

10.1038/s41467-021-22202-3 ◽

2021 ◽

Vol 12 (1) ◽

Author(s):

Meir Meshulam ◽

Liat Hasenfratz ◽

Hanna Hillman ◽

Yun-Fei Liu ◽

Mai Nguyen ◽

...

Keyword(s):

Computer Science ◽

Learning Outcomes ◽

Brain Activity ◽

Activity Patterns ◽

Real Life ◽

Final Exam ◽

Neural Representations ◽

Real Life Setting ◽

The Right ◽

Mri Study

AbstractDespite major advances in measuring human brain activity during and after educational experiences, it is unclear how learners internalize new content, especially in real-life and online settings. In this work, we introduce a neural approach to predicting and assessing learning outcomes in a real-life setting. Our approach hinges on the idea that successful learning involves forming the right set of neural representations, which are captured in canonical activity patterns shared across individuals. Specifically, we hypothesized that learning is mirrored in neural alignment: the degree to which an individual learner’s neural representations match those of experts, as well as those of other learners. We tested this hypothesis in a longitudinal functional MRI study that regularly scanned college students enrolled in an introduction to computer science course. We additionally scanned graduate student experts in computer science. We show that alignment among students successfully predicts overall performance in a final exam. Furthermore, within individual students, we find better learning outcomes for concepts that evoke better alignment with experts and with other students, revealing neural patterns associated with specific learned concepts in individuals.

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