Value of Eye Movement Exam in Aiding Precise Localization in Stroke (P1.016)

We present an unusual presentation of midbrain stroke presenting with bilateral ptosis in an African American male with vascular risk factors and concurrent use of bevacizumab. This case illustrates how detailed knowledge of anatomy and detailed neurologic exam remain valuable tools for localizing and diagnosing subtle presentations of common neurologic disease. Case description: A 69 year-old African American man with vascular risk factors including hypertension, hyperlipidemia and poorly controlled diabetes experienced sudden onset horizontal diplopia associated with fatigue. The patient presented to the Emergency Department where exam revealed bilateral ptosis and left internuclear opthalmoplegia (INO). Initial NIH stroke scale was 2 for partial gaze palsy and sensory deficits. He did not qualify for thrombolysis. The patient was admitted to the neurology service with suspected stroke. Magnetic resonance imaging of the brain revealed a midline midbrain diffusion restriction with apparent diffusion coefficient correlate just ventral to the aqueduct of Sylvius, slightly more extended to the right, consistent with subacute ischemic stroke involving the nucleus of oculomotor nerve and adjacent medial longitudinal fasciculus. Magnetic resonance angiography of the head and neck did not show significant intracranial or extracranial vascular disease. Transthoracic echocardiogram revealed normal heart function and no patent foramen ovale. The patient was started on aspirin and a...
Source: Neurology - Category: Neurology Authors: Tags: Cerebrovascular Disease and Interventional Neurology I ePosters Source Type: research