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1.
BMC Neurol ; 21(1): 492, 2021 Dec 20.
Artigo em Inglês | MEDLINE | ID: mdl-34930175

RESUMO

BACKGROUND: Bilateral facial colliculus syndrome is a rare clinical presentation in patient with pontine infarction. We herein described a case of bilateral facial paralysis and complete horizontal gaze palsy possibly caused by paradoxical embolization from patent foramen ovale related stroke. CASE PRESENTATION: A 55-year-old male presented with sudden onset of complete peripheral facial palsy and horizontal gaze palsy after Valsava maneuver. MRI revealed symmetric involvement of bilateral pontine tegmentum in accordance with the location of facial colliculus. CSF analysis and follow-up MRI showed no evidence of central demyelinating disease. Subsequent echocardiography revealed patent foramen ovale and closure surgery was performed. CONCLUSIONS: Facial colliculus syndrome with symmetric dorsal pontine tegmentum involvement may a rare manifestation in posterior circulation stroke.


Assuntos
Forame Oval Patente , Tegmento Pontino , Humanos , Infarto , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Síndrome
2.
J Stroke Cerebrovasc Dis ; 29(11): 105139, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33066880
3.
BMJ Case Rep ; 13(9)2020 Sep 13.
Artigo em Inglês | MEDLINE | ID: mdl-32928818

RESUMO

A 30-year-old woman presented with recurrent hiccups, vomiting and painful diminution of vision and gait instability for 1 day. She had one-and-a-half syndrome, bilateral seventh cranial nerve paresis with bilateral symptomatic optic neuritis and left-sided ataxic haemiparesis. We described her disorder as the 'twenty syndrome' (11/2+7+7+2+2+½=20). MRI of her brain revealed demyelination predominantly in right posterolateral aspect of pons, medulla and bilateral optic nerves. Serum antiaquaporin-4 antibody came out positive. Thus, she was diagnosed as neuromyelitis optica spectrum disorder (NMOSD). She responded brilliantly to immunosuppressive therapy. This is the first ever reported case of the 'twenty syndrome' secondary to cerebral NMOSD.


Assuntos
Ataxia Cerebelar/imunologia , Paralisia Facial/imunologia , Imunossupressores/uso terapêutico , Neuromielite Óptica/diagnóstico , Transtornos da Motilidade Ocular/imunologia , Neurite Óptica/imunologia , Adulto , Aquaporina 4/imunologia , Autoanticorpos/sangue , Autoanticorpos/imunologia , Ataxia Cerebelar/sangue , Ataxia Cerebelar/diagnóstico , Ataxia Cerebelar/tratamento farmacológico , Paralisia Facial/sangue , Paralisia Facial/diagnóstico , Paralisia Facial/tratamento farmacológico , Feminino , Humanos , Imageamento por Ressonância Magnética , Neuromielite Óptica/sangue , Neuromielite Óptica/complicações , Neuromielite Óptica/imunologia , Transtornos da Motilidade Ocular/sangue , Transtornos da Motilidade Ocular/diagnóstico , Transtornos da Motilidade Ocular/tratamento farmacológico , Nervo Óptico/diagnóstico por imagem , Nervo Óptico/imunologia , Neurite Óptica/sangue , Neurite Óptica/diagnóstico , Neurite Óptica/tratamento farmacológico , Tegmento Pontino/diagnóstico por imagem , Tegmento Pontino/imunologia , Síndrome , Resultado do Tratamento
4.
Medicine (Baltimore) ; 99(30): e20816, 2020 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-32791670

RESUMO

RATIONALE: To report the management of recalcitrant neurotrophic keratopathy in a pediatric patient affected by pontine tegmental cap dysplasia (PTCD) using topical human recombinant nerve growth factor (hrNGF, Cenegermin 20 µg/ml). To the best of our knowledge the present case is one of the few described in patients with congenital NK treated with Cenegermin, and the first in a patient affected by PTCD. PATIENT CONCERNS: A 9-year-old patient, affected by PTCD with bilateral cranial nerve V1 and VIII palsies, was referred to our hospital for visual disturbances and redness of the right eye due to persistent neurotrophic epithelial defect. The patient presented marked developmental delay, ataxia, bilateral hypoacusia, and bilateral corneal severe hypoaesthesia. Ocular history revealed multiple treatments in order to treat neurotrophic ulcer in the left eye. Four years later, he developed a persistent epithelial defect with corneal anesthesia in the right eye. DIAGNOSES: The impaired trigeminal nerve function, due to the underlying congenital disease, led to the development of moderate NK (stage II) in the right eye and a mild NK (stage I) in the left eye. INTERVENTIONS: Cenegermin 20 µg/ml eye-drop was administered in both eyes. Treatment was continued for 8 weeks. The patient was assessed after 4 and 8 week of treatment. At each follow-up visit, treatment efficacy and adverse events were evaluated. OUTCOMES: The use of Cenegermin eye drops facilitated the remarkable resolution of the neurotrophic keratopathy and the improvement of corneal sensitivity in both eyes. No local or systemic adverse events were observed. LESSONS: Topical Cenegermin 20 µg/ml was well-tolerated and may represent a valuable therapeutic option in the management of pediatric neurotrophic keratopathy.


Assuntos
Doenças da Córnea/tratamento farmacológico , Fator de Crescimento Neural/uso terapêutico , Tegmento Pontino/anormalidades , Criança , Doenças da Córnea/etiologia , Humanos , Masculino , Soluções Oftálmicas , Proteínas Recombinantes
5.
J Physiol Biochem ; 76(4): 561-572, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32812210

RESUMO

Connections between the midbrain dorsolateral periaqueductal grey (dlPAG) and the pontine A5 region have been shown. The stimulation of both regions evokes similar cardiovascular responses: tachycardia and hypertension. Accordingly, we have studied the interactions between dlPAG and A5 region in spontaneously breathing anesthetized rats. dlPAG was electrically stimulated (20-30 µA 1-ms pulses were given for 5 s at 100 Hz). Changes in the evoked cardiorespiratoy response were analysed before and after ipsilateral microinjections of muscimol (GABAergic agonist, 50 nl, 0.25 nmol, 5 s) within the A5 region. Electrical stimulation of the dlPAG produces, in the rat, a response characterized by tachypnoea (p < 0.001), hypertension (p < 0.001) and tachycardia (p < 0.001). The increase in respiratory rate was due to a decrease in expiratory time (p < 0.01). Pharmacological inhibition of the A5 region with muscimol produced a marked reduction of the tachycardia (p < 0.001) and the tachypnoea (p < 0.01) evoked from the dlPAG. Finally, to assess functional interactions between A5 and dlPAG, extracellular activity of putative A5 neurones were recorded during dlPAG electrical stimulation. Forty A5 cells were recorded, 16 of which were affected by dlPAG stimulation (40%). 4 cells showed activation, 5 cells excitation and 7 cells decreased spontaneous activity to dlPAG stimulation (p < 0.001). These results confirm a link between the A5 region and dlPAG. The potential role of these connections in the modulation of dlPAG evoked cardiorespiratory responses and their possible clinical implications are discussed.


Assuntos
Mesencéfalo/fisiologia , Neurônios/citologia , Substância Cinzenta Periaquedutal/fisiologia , Tegmento Pontino/fisiologia , Animais , Estimulação Elétrica , Hipertensão , Masculino , Ratos , Ratos Sprague-Dawley , Taquicardia
6.
Acta Neuropathol Commun ; 8(1): 147, 2020 08 26.
Artigo em Inglês | MEDLINE | ID: mdl-32847628

RESUMO

We document the neuropathologic findings of a 73-year old man who died from acute cerebellar hemorrhage in the context of relatively mild SARS-CoV2 infection. The patient developed sudden onset of headache, nausea, and vomiting, immediately followed by loss of consciousness on the day of admission. Emergency medical services found him severely hypoxemic at home, and the patient suffered a cardiac arrest during transport to the emergency department. The emergency team achieved return of spontaneous circulation after over 17 min of resuscitation. A chest radiograph revealed hazy bilateral opacities; and real-time-PCR for SARS-CoV-2 on the nasopharyngeal swab was positive. Computed tomography of the head showed a large right cerebellar hemorrhage, with tonsillar herniation and intraventricular hemorrhage. One day after presentation, he was transitioned to comfort care and died shortly after palliative extubation. Autopsy performed 3 h after death showed cerebellar hemorrhage and acute infarcts in the dorsal pons and medulla. Remarkably, there were microglial nodules and neuronophagia bilaterally in the inferior olives and multifocally in the cerebellar dentate nuclei. This constellation of findings has not been reported thus far in the context of SARS-CoV-2 infection.


Assuntos
Infartos do Tronco Encefálico/patologia , Doenças Cerebelares/patologia , Infecções por Coronavirus/patologia , Hemorragias Intracranianas/patologia , Microglia/patologia , Neurônios/patologia , Fagocitose , Pneumonia Viral/patologia , Idoso , Betacoronavirus , Infartos do Tronco Encefálico/complicações , Infartos do Tronco Encefálico/diagnóstico por imagem , COVID-19 , Doenças Cerebelares/complicações , Doenças Cerebelares/diagnóstico por imagem , Núcleos Cerebelares/patologia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Cefaleia/etiologia , Parada Cardíaca/etiologia , Humanos , Hipóxia/etiologia , Hemorragias Intracranianas/complicações , Hemorragias Intracranianas/diagnóstico por imagem , Masculino , Bulbo/diagnóstico por imagem , Bulbo/patologia , Núcleo Olivar/patologia , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Tegmento Pontino/diagnóstico por imagem , Tegmento Pontino/patologia , SARS-CoV-2 , Tomografia Computadorizada por Raios X
7.
Dev Neurobiol ; 80(5-6): 178-199, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32628361

RESUMO

Smoking during pregnancy is associated with deleterious physiological and cognitive effects on the offspring, which are likely due to nicotine-induced alteration in the development of neurotransmitter systems. Prenatal nicotine exposure (PNE) in rodents is associated with changes in behaviors controlled in part by the pontine laterodorsal tegmentum (LDT), and LDT excitatory signaling is altered in a sex and age-dependent manner by PNE. As effects on GABAergic LDT signaling are unknown, we used calcium imaging to evaluate GABAA receptor- (GABAA R as well as GABAA -ρ R) and GABAB receptor (GABAB R)-mediated calcium responses in LDT brain slices from female and male PNE mice in two different age groups. Overall, in older PNE females, changes in calcium induced by stimulation of GABAA R and GABAB R, including GABAA -ρ R were shifted toward calcium rises. In both young and old males, PNE was associated with alterations in calcium mediated by all three receptors; however, the GABAA R was the most affected. These results show for the first time that PNE is associated with alterations in GABAergic transmission in the LDT in a sex- and age-dependent manner, and these data are the first to show PNE-associated alterations in functionality of GABA receptors in any nucleus. PNE-associated alterations in LDT GABAergic transmission within the LDT would be expected to alter output to target regions and could play a role in LDT-implicated, negative behavioral outcomes following gestational exposure to smoking. Accordingly, our data provide further supportive evidence of the importance of eliminating the consumption of nicotine during pregnancy.


Assuntos
Nicotina/farmacologia , Agonistas Nicotínicos/farmacologia , Tegmento Pontino/metabolismo , Efeitos Tardios da Exposição Pré-Natal/metabolismo , Receptores de GABA-A/metabolismo , Receptores de GABA-B/metabolismo , Fumar/efeitos adversos , Fatores Etários , Animais , Cálcio/metabolismo , Modelos Animais de Doenças , Feminino , Masculino , Camundongos , Tegmento Pontino/efeitos dos fármacos , Gravidez , Efeitos Tardios da Exposição Pré-Natal/etiologia , Receptores de GABA-A/efeitos dos fármacos , Receptores de GABA-B/efeitos dos fármacos , Fatores Sexuais
8.
J Comp Neurol ; 528(18): 3229-3244, 2020 12 15.
Artigo em Inglês | MEDLINE | ID: mdl-32678456

RESUMO

The large external pinnae and extensive vocal repertoire of the African wild dog (Lycaon pictus) has led to the assumption that the auditory system of this unique canid may be specialized. Here, using cytoarchitecture, myeloarchitecture, and a range of immunohistochemical stains, we describe the systems-level anatomy of the auditory system of the African wild dog. We observed the cochlear nuclear complex, superior olivary nuclear complex, lateral lemniscus, inferior colliculus, medial geniculate body, and auditory cortex all being in their expected locations, and exhibiting the standard subdivisions of this system. While located in the ectosylvian gyri, the auditory cortex includes several areas, resembling the parcellation observed in cats and ferrets, although not all of the auditory areas known from these species could be identified in the African wild dog. These observations suggest that, broadly speaking, the systems-level anatomy of the auditory system, and by extension the processing of auditory information, within the brain of the African wild dog closely resembles that observed in other carnivores. Our findings indicate that it is likely that the extraction of the semantic content of the vocalizations of African wild dogs, and the behaviors generated, occurs beyond the classically defined auditory system, in limbic or association neocortical regions involved in cognitive functions. Thus, to obtain a deeper understanding of how auditory stimuli are processed, and how communication is achieved, in the African wild dog compared to other canids, cortical regions beyond the primary sensory areas will need to be examined in detail.


Assuntos
Animais Selvagens/anatomia & histologia , Canidae/anatomia & histologia , Núcleo Coclear/anatomia & histologia , Nervo Vestibulococlear/anatomia & histologia , África , Animais , Córtex Auditivo , Vias Auditivas , Núcleo Coclear/fisiologia , Cães , Corpos Geniculados , Colículos Inferiores , Tegmento Pontino , Núcleos Talâmicos , Nervo Vestibulococlear/fisiologia
9.
J Child Neurol ; 35(8): 501-508, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32507080

RESUMO

AIM: To investigate etiology and prognostic significance of pontine tegmentum lesions accompanying a cluster of acute flaccid myelitis. METHOD: We retrospectively examined patients from 6 centers in Turkey who manifested encephalitis or myelitis associated with dorsal pontine lesions on magnetic resonance imaging (MRI) between July 2018 and February 2019. RESULTS: Twenty-two patients were evaluated. Ten of 22 (45%) presented with acute paralysis and 12 of 22 (55%) with brainstem symptoms only. Reverse transcription polymerase chain reaction for enterovirus was positive in 2 patients' respiratory tract. Other etiologic factors were detected in 10 cases. On follow-up, patients presenting with symptoms of myelitis developed motor sequalae although spinal cord lesions on MRI resolved in 5 of 9 (55%). Encephalitic symptoms, present in 17 cases, recovered in 13 (76%), and brain MRI showed complete or near-complete resolution in 11 of 14 (78%). CONCLUSION: Various etiologic agents can be detected in patients with pontine involvement, even in a series collected during an outbreak of EV-D68. Encephalitis has a fair outcome but clinical recovery is slow and motor sequalae are frequent in spinal involvement, irrespective of follow-up spinal MRI findings.


Assuntos
Viroses do Sistema Nervoso Central/diagnóstico por imagem , Infecções por Enterovirus/diagnóstico por imagem , Mielite/diagnóstico por imagem , Doenças Neuromusculares/diagnóstico por imagem , Tegmento Pontino/diagnóstico por imagem , Adolescente , Criança , Pré-Escolar , Diagnóstico Diferencial , Enterovirus , Feminino , Humanos , Lactente , Imageamento por Ressonância Magnética , Masculino , Prognóstico
10.
Mol Brain ; 13(1): 67, 2020 05 05.
Artigo em Inglês | MEDLINE | ID: mdl-32370769

RESUMO

The linear nucleus (Li) was identified in 1978 from its projections to the cerebellum. However, there is no systematic study of its connections with other areas of the central nervous system possibly due to the challenge of injecting retrograde tracers into this nucleus. The present study examines its afferents from some nuclei involved in motor and cardiovascular control with anterograde tracer injections. BDA injections into the central amygdaloid nucleus result in labeled fibers to the ipsilateral Li. Bilateral projections with an ipsilateral dominance were observed after injections in a) jointly the paralemniscal nucleus, the noradrenergic group 7/ Köllike -Fuse nucleus/subcoeruleus nucleus, b) the gigantocellular reticular nucleus, c) and the solitary nucleus/the parvicellular/intermediate reticular nucleus. Retrogradely labeled neurons were observed in Li after BDA injections into all these nuclei except the central amygdaloid and the paralemniscal nuclei. Our results suggest that Li is involved in a variety of physiological functions apart from motor and balance control it may exert via its cerebellar projections.


Assuntos
Biotina/análogos & derivados , Dextranos/farmacologia , Núcleo Dorsal da Rafe/efeitos dos fármacos , Neurônios/efeitos dos fármacos , Vias Aferentes , Tonsila do Cerebelo/citologia , Tonsila do Cerebelo/efeitos dos fármacos , Tonsila do Cerebelo/metabolismo , Animais , Biotina/farmacologia , Cerebelo/efeitos dos fármacos , Cerebelo/metabolismo , Núcleo Dorsal da Rafe/citologia , Núcleo Dorsal da Rafe/metabolismo , Bulbo/metabolismo , Camundongos , Camundongos Endogâmicos C57BL , Vias Neurais/efeitos dos fármacos , Vias Neurais/metabolismo , Neurônios/citologia , Neurônios/metabolismo , Tegmento Pontino/citologia , Tegmento Pontino/efeitos dos fármacos , Tegmento Pontino/metabolismo , Núcleos do Trigêmeo/citologia , Núcleos do Trigêmeo/efeitos dos fármacos , Núcleos do Trigêmeo/metabolismo , Núcleos Vestibulares/citologia , Núcleos Vestibulares/efeitos dos fármacos , Núcleos Vestibulares/metabolismo
11.
Rinsho Shinkeigaku ; 60(6): 434-440, 2020 Jun 06.
Artigo em Japonês | MEDLINE | ID: mdl-32435047

RESUMO

We herein reported a patient with acute ischemic stroke in the bilateral medial medullary and the left tegmentum of the pons who presented with various neurological symptoms. Fusing digital subtraction angiography (DSA) and MRI (DSA-MR fusion imaging) could reveal the infarct-relevant arteries. A 41-year-old male presented with headache, bilateral arm's dysesthesia, quadriplegia, left Horner's syndrome, upbeat nystagmus, internuclear ophthalmoplegia and left peripheral facial paralysis. Diffusion weighted MRI (DWI) revealed the high intensity lesion in the bilateral medial medullary and the left tegmentum of the pons. MRA showed right vertebral artery (VA) occlusion. A high intensity on T1 weighted imaging was shown on the right VA vessel wall. DSA-MR fusion imaging revealed the anterior spinal artery (ASA) occlusion proximal to the infarction. The stenosis was located at the origin of the right VA perforating branch distributing into the infarct lesion. The steno-occlusive lesion of ASA and VA perforating branch due to VA dissection resulted in infarction in the pontomedullary junction and caused various neurological symptoms. DSA-MR fusion imaging would prove the radiological anatomy of infarct-relevant arteries and clarify the etiology of ischemic stroke.


Assuntos
Angiografia Digital/métodos , Arteriopatias Oclusivas/diagnóstico por imagem , Angiografia Cerebral/métodos , Imageamento por Ressonância Magnética/métodos , Bulbo/irrigação sanguínea , Tegmento Pontino/irrigação sanguínea , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/etiologia , Artéria Vertebral/diagnóstico por imagem , Adulto , Arteriopatias Oclusivas/complicações , Humanos , Masculino , Transtornos da Motilidade Ocular/etiologia
12.
Cornea ; 39(12): 1516-1519, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32398424

RESUMO

PURPOSE: To describe the ocular complications experienced by patients with pontine tegmental cap dysplasia (PTCD) and the management strategies used to care for these children. METHODS: Subjects with PTCD were recruited through social media advertisement and completed a survey gathering information on potential ocular problems related to the patient's PTCD disease and any current or previous treatments. RESULTS: Twenty-two patients or guardians completed the survey. Neurotrophic cornea was the most common ocular diagnosis (82%), followed by facial palsy (59%), dry eye syndrome (59%), and blepharitis (55%). Other diagnoses included cortical visual impairment (27%), strabismus (27%), amblyopia (18%), and nystagmus (18%). Common treatment modalities included lubricating eye drops (59%) or ointment (50%), contact lenses (14%), punctal plugs (27%), glasses (45%), and patching (18%). The most common surgical interventions were temporary or permanent tarsorrhaphy (64%) and amniotic membrane grafts (23%). In total, 68% of families reported self-injury to eyes and 91% reported the child to be primarily a visual learner. CONCLUSIONS: PTCD is a newly described, very rare disorder with a variety of vision-threatening ocular manifestations. It is essential that the ophthalmologist be aware of the potential for neurotrophic cornea because timely treatment could prevent corneal scarring, perforation, and blindness.


Assuntos
Doenças Cerebelares/diagnóstico , Doenças dos Nervos Cranianos/diagnóstico , Deficiências do Desenvolvimento/diagnóstico , Oftalmopatias/diagnóstico , Malformações do Sistema Nervoso/diagnóstico , Tegmento Pontino/anormalidades , Adolescente , Doenças Cerebelares/etiologia , Pré-Escolar , Doenças dos Nervos Cranianos/etiologia , Deficiências do Desenvolvimento/etiologia , Oftalmopatias/etiologia , Feminino , Humanos , Masculino , Malformações do Sistema Nervoso/etiologia
13.
Neurologist ; 25(3): 82-84, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32358467

RESUMO

INTRODUCTION: Wall-eyed bilateral internuclear ophthalmoplegia (WEBINO) is a rare symptom. Several studies have reported that a small brainstem lesion could cause WEBINO. CASE REPORT: The authors present the case of an 88-year-old female individual who developed sudden-onset diplopia and gait disturbance. Neurological examination revealed WEBINO with convergence impairment, gaze-evoked upward nystagmus on upward gaze, and bilateral limb ataxia. Brain magnetic resonance imaging revealed a small paramedian pontine tegmentum infarction, responsible for the symptoms. A literature review of WEBINO in ischemic stroke revealed that most patients exhibited impaired convergence and other neurological symptoms. CONCLUSION: Gaze-evoked upward nystagmus on upward gaze and bilateral limb ataxia accompanied by WEBINO due to a small brainstem lesion were the characteristic findings of our case.


Assuntos
AVC Isquêmico/complicações , Transtornos da Motilidade Ocular/diagnóstico , Transtornos da Motilidade Ocular/etiologia , Idoso de 80 Anos ou mais , Diplopia/complicações , Feminino , Transtornos Neurológicos da Marcha/complicações , Humanos , AVC Isquêmico/diagnóstico por imagem , AVC Isquêmico/patologia , Transtornos da Motilidade Ocular/patologia , Tegmento Pontino/diagnóstico por imagem , Tegmento Pontino/patologia
16.
J Stroke Cerebrovasc Dis ; 29(6): 104750, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32220556

RESUMO

Isolated pontine infarcts are common and are often associated with well-described syndromes that are classified based on their specific clinical presentation and arterial stroke territories. Here we present a case of acute combined diplopia and unilateral lower extremity sensory abnormality. Diffusion-weighted magnetic resonance imaging revealed a punctate area of acute ischemia in the right medial pontine mid-tegmentum. These findings suggest a unique pontine stroke syndrome characterized by acute ischemic injury at the intersection of the medial lemniscus and cranial nerve VI.


Assuntos
Doenças do Nervo Abducente/etiologia , Infartos do Tronco Encefálico/complicações , Diplopia/etiologia , Extremidade Inferior/inervação , Tegmento Pontino/irrigação sanguínea , Transtornos das Sensações/etiologia , Doenças do Nervo Abducente/diagnóstico , Doenças do Nervo Abducente/fisiopatologia , Infartos do Tronco Encefálico/diagnóstico por imagem , Infartos do Tronco Encefálico/fisiopatologia , Imagem de Difusão por Ressonância Magnética , Diplopia/diagnóstico , Diplopia/fisiopatologia , Feminino , Humanos , Pessoa de Meia-Idade , Tegmento Pontino/diagnóstico por imagem , Valor Preditivo dos Testes , Transtornos das Sensações/diagnóstico , Transtornos das Sensações/fisiopatologia , Síndrome
20.
BMC Neurol ; 19(1): 254, 2019 Oct 27.
Artigo em Inglês | MEDLINE | ID: mdl-31656191

RESUMO

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.


Assuntos
Esclerose Múltipla/complicações , Esclerose Múltipla/patologia , Transtornos da Motilidade Ocular/etiologia , Tegmento Pontino/patologia , Adolescente , Feminino , Humanos , Imageamento por Ressonância Magnética
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