Isolated Cranial Nerve-III Palsy Secondary to Perimesencephalic Subarachnoid Hemorrhage

We describe isolated cranial nerve-III palsy as a rare clinical finding in a patient with perimesencephalic subarachnoid hemorrhage. In this unusual case, the patient presented with complete cranial nerve-III palsy including ptosis and pupillary involvement. Initial studies revealed subarachnoid hemorrhage in the perimesencephalic, prepontine, and interpeduncular cisterns. Angiographic studies were negative for an intracranial aneurysm. The patient’s neurological deficits improved with no residual deficits on follow-up several months after initial presentation. Our case report supports the notion that patients with perimesencephalic subarachnoid hemorrhage have an excellent prognosis. Our report further adds a case of isolated cranial nerve-III palsy as a rare initial presentation of this type of bleeding, adding to the limited body of the literature

Cranial Nerve-VI Palsy as the Main Clinical Manifestation of Neurosarcoidosis.

INTRODUCTION: Sarcoidosis is a chronic, systemic, inflammatory disorder that is characterized by the formation of noncaseating granulomas. Patients may present with cranial nerve palsy, paresthesia, paresis, pyramidal signs, progressive cognitive decline, urinary retention, seizures, or hypothalamic-pituitary syndrome. Although the diagnosis of neurosarcoidosis can be challenging, neurological manifestations of sarcoidosis occur more frequently than previously described. CASE REPORT: A 23-year-old African American man presented to our emergency department with diplopia, which was worsened on left horizontal gaze. On the day of admission, he had a witnessed seizure. Laboratory studies were significant only for mild leukopenia and erythrocyte sedimentation rate of 17 mm/h. Brain magnetic resonance imaging revealed diffuse thickening and enhancement of the dura, mild mass effect, and soft tissue enhancement through the foramen rotundum and left orbital apex. The patient was treated with intravenous methylprednisolone and discharged on 60 mg oral prednisone daily followed by a taper over a 2-month period. CONCLUSIONS: Our case demonstrates that mild neurological deficits can be the initial presentation of neurosarcoidosis in patients with undiagnosed or proven sarcoidosis

Serial Heart Rate Variability Testing for the Evaluation of Autonomic Dysfunction After Stroke.

BACKGROUND AND PURPOSE: Autonomic dysfunction has been described as a frequent complication of stroke that could involve the cardiac, respiratory, sudomotor, and sexual systems. Cardiac autonomic dysfunction after stroke is one of the most recognized and has been described to increase the rate of mortality and morbidity. METHODS: We report two cases of stroke-one hemorrhagic and one ischemic-and describe heart rate variability during the patients\u27 hospitalizations with improvement reported for each patient several days after stroke onset. RESULTS: The first case demonstrated autonomic dysfunction with severe reduction of HRV after a right parietal hemorrhagic stroke. The second case demonstrated similar findings in a patient with acute ischemic stroke. In both cases, normalization of heart rate variability occurred several weeks after stroke symptoms onset and was paralleled by a dramatic improvement of the clinical status. CONCLUSION: Our data established that serial HRV testing is a noninvasive tool that could be utilized as a marker to evaluate the dynamics of acute stroke

Central Hypoventilation: A Rare Complication of Wallenberg Syndrome

Central alveolar hypoventilation disorders denote conditions resulting from underlying neurologic disorders affecting the sensors, the central controller, or the integration of those signals leading to insufficient ventilation and reduction in partial pressures of oxygen. We report a patient who presented with a left lateral medullary ischemic stroke after aneurysm repair who subsequently developed a rare complication of CAH. Increased awareness of this condition’s clinical manifestations is crucial to make an accurate diagnosis and understand its complications and prognosis

Abnormal Magnetic Resonance Imaging and Hemichorea Associated With Non-Ketotic Hyperglycemia.

Unilateral basal ganglia abnormalities on brain imaging secondary to non-ketotic hyperglycemia have been reported in the literature with different clinical manifestations. We present two cases of nonketotic hyperglycemia, acute chorea, and reversible CT and MRI findings. There seems to be a wide spectrum of pathological mechanisms underlying this entity, but none of the studies investigating the potential mechanisms of the radiological and clinical presentations have been conclusive

Isolated Cranial Nerve-III Palsy Secondary to Perimesencephalic Subarachnoid Hemorrhage.

We describe isolated cranial nerve-III palsy as a rare clinical finding in a patient with perimesencephalic subarachnoid hemorrhage. In this unusual case, the patient presented with complete cranial nerve-III palsy including ptosis and pupillary involvement. Initial studies revealed subarachnoid hemorrhage in the perimesencephalic, prepontine, and interpeduncular cisterns. Angiographic studies were negative for an intracranial aneurysm. The patient\u27s neurological deficits improved with no residual deficits on follow-up several months after initial presentation. Our case report supports the notion that patients with perimesencephalic subarachnoid hemorrhage have an excellent prognosis. Our report further adds a case of isolated cranial nerve-III palsy as a rare initial presentation of this type of bleeding, adding to the limited body of the literature

Postictal Todd\u27s Paralysis Associated with Focal Cerebral Hypoperfusion on Magnetic Resonance Perfusion Studies.

BACKGROUND: The exact underlying physiology of postictal motor deficits, known as Todd\u27s paralysis, is not well understood and its vascular perfusion physiology is not well studied. Reversible postictal perfusion abnormalities have been sparsely described in the literature. METHODS: We report abnormal brain magnetic resonance perfusion maps in a 9-year-old boy who presented with postictal left hemiparesis. This case correlates postictal hemispheric cerebral hypoperfusion with clinical evidence of Todd\u27s paralysis. CONCLUSIONS: Our case provides an insight into the potential pathophysiology mechanism underlying Todd\u27s paralysis and the practicality of magnetic resonance perfusion studies in localizing an epileptogenic zone in the postictal patient