Eye Blink-Associated Saccades.

Saccades function to bring targets of interest into the field of view. They are one of the four types of basic eye movements in humans, all of which are generated and modulated by components of a complex eye movement network, involving cortical eye fields, thalami, basal ganglia, cerebellum, and brainstem structures. Similarly, blinks are presumed to be generated by a blink center involving complex cortical and subcortical pathways. An association between saccades and blinks is well established; when these circuits are disrupted, normal saccadic parameters change. We report a case of a 48-year-old female who presented with fatigue and weakness. She had a complicated medical history, including drug-resistant epilepsy with subsequent vagus nerve stimulator (VNS) placement, right anterior temporal lobectomy, and craniotomy for a residual right temporal lobectomy and amygdalohippocampectomy. The latter was complicated by ischemic right middle cerebral artery (MCA) territory stroke with residual left hemiplegia. Her examination was unremarkable with regards to the presenting complaints, but one unique finding was observed; she demonstrated abnormal conjugate eye movements to the left associated with each blink. These eye movements continued to be present even after the patient's ability to fixate on an object was removed. It was unclear how long this finding had been present. A review of her MRI of the brain from 10 months prior showed encephalomalacia and surrounding gliosis in the right MCA territory, right temporal laminar necrosis, right basal ganglia and parietal lobe microhemorrhages, ex vacuo dilatation of the right lateral ventricle, and a rightward midline shift. Saccadic abnormalities have been reported in a variety of conditions. The eye blink-associated saccades seen here are rare. To our knowledge, only one other patient has been reported with similar blink-associated eye movements after brain injury following a right MCA territory stroke. The exact mechanism underlying these eye movements is unclear, but may involve aberrant or disrupted neuronal signaling in cortical and/or basal ganglia components of the eye movement network, or related to an as yet unknown blink-saccadic regulatory mechanism.

Sleep-related Eating Disorder in a Patient with Parkinson's Disease.

Sleep disorders constitute a major aspect of the non-motor symptoms of Parkinson's disease (PD). Rapid eye movement (REM) behavior disorders are the most frequently experienced parasomnias in patients with PD. Non-REM sleep disorders like confusional arousals, sleep terrors, sleepwalking, and sleep-related eating disorder (SRED) are also associated with PD. Parasomnias can affect the quality of life of the patients as well as the night time sleep of their bed partners. Hence, it is important for physicians to recognize the occurrence of parasomnias in PD. We report an unusual case of PD with SRED along with obstructive sleep apnea (OSA) and REM behavior disorder. To our knowledge, only two cases have been reported in the literature highlighting the association of SRED with PD. We also explain the different night-time eating disorders like nocturnal eating syndrome and binge eating syndrome, which can be seen in PD, and differentiate them from SRED.

Mal de Debarquement Syndrome: A Case Report.

Mal de Debarquement syndrome (MdDS) is an uncommon neurological disorder seen in women, mostly in their fourth decade of life. It is characterized by a constant sensation of swaying or motion after one disembarks from a vehicle such as a ship or plane following a lengthy trip. These symptoms temporarily subside when the patient is subjected again to passive motion like driving a car. There are no definitive diagnostic tests for Mal de Débarquement syndrome. It is a diagnosis of exclusion and does not have an effective treatment. The symptoms usually resolve spontaneously in about a year. We report a case of a 47-year-old female who presented with a feeling of imbalance following about a four-week cruise, which temporarily subsides during a bicycle ride or a car drive. We report this case, as this condition may not be well-known and probably under-reported. Prospective travelers should be warned and patients can perhaps be cautiously reassured.

Movement Disorders and Deep Brain Stimulation in the Middle East.

BACKGROUND: Deep brain stimulation (DBS) is a well-established neuromodulation therapy for advanced Parkinson disease, essential tremor and dystonia. In as much as this therapy is being developed in the Middle East, a better understanding of the incidence and prevalence of movement disorders, health care, and social framework is required for the region. METHODS: We reviewed current literature on the incidence and prevalence of various movement disorders in the Middle East amenable to DBS surgery. We also assessed recent efforts to develop DBS in the region. RESULTS: Available data on incidence and prevalence of movement disorders in the Middle East are old, inconclusive, and conflicting. We identify key areas such as cultural background, availability of accessible information, training, infrastructure, and public support groups in the region that may pose challenges. CONCLUSIONS: The Middle East is projected to be a growing market for neuromodulation. The available data on incidence and prevalence of movement disorders is from studies that were small, partial, and old, with inconsistent results, highlighting the need for newer, better-designed, and larger studies. DBS in the Middle East will need assessment of incidence and prevalence of movement disorders, existing challenges to its application, and focused efforts on key opportunities to foster development of DBS for this underserved region. This article is an attempt to identify and explore these challenges and propose solutions in anticipation.

Atypical Variant of Posterior Reversible Encephalopathy Syndrome in the Setting of Renovascular Hypertension: Case Report and Review of Literature.

Posterior reversible encephalopathy syndrome (PRES) is a clinico-radiologic syndrome resulting in subcortical vasogenic edema appreciated on T2/fluid-attenuated inversion recovery (FLAIR) sequence of magnetic resonance imaging (MRI). PRES classically involves bilateral parieto-occipital lobes and is usually reversible. Atypical variant of PRES includes the involvement of brainstem, basal ganglia, thalami, or periventricular white matter. We report an unusual case of PRES with isolated brainstem involvement with periventricular white matter changes in a patient with renovascular hypertension from unilateral renal artery stenosis. To our knowledge, this is the first case of secondary hypertension from renal artery stenosis resulting in the atypical variant of PRES.