A 12-Year-Old African American Girl With Subacute Bilateral Ophthalmoplegia

A twelve-year-old African-American female presented with two week history of progressively worsening headache and fatigue, and vision difficulties for the past week. The physical examination was normal. The neurological evaluation was normal, except for cranial nerves (CN) testing, which showed bilateral restriction of adduction (CN III) and up gaze (CN IV) motions, vertical nystagmus, and left side facial paresis of central origin (CN VII). The bilateral exotropia and ophthalmoplegia are characteristics of WEBINO (Wall-Eyed Bilateral Intranuclear Ophthalmoplegia) syndrome, associated to a brain stem structural lesion. The following causes were evaluated and ruled out: tumor, infection, ischemic stroke, non-infectious inflammation. Pediatric Acquired Demyelinating Syndromes were then considered. Neuromyelitis Optica was ruled out in the absence of neuritis and normal spinal cord MRI. The differential diagnosis between Clinically Isolated Syndrome and Acute Demyelinating Encephalomyelitis, causing an isolated brain stem syndrome, is discussed.
Source: Seminars in Pediatric Neurology - Category: Neurology Authors: Source Type: research

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Source: Journal of Cardiovascular Electrophysiology - Category: Cardiology Authors: Tags: REVIEW Source Type: research
Authors: White H, Venkatesh B, Jones M, Kruger PS, Walsham J, Fuentes H Abstract Objective: Although extensively studied in children, the safety and tolerability of ketone supplementation in adults is unclear, particularly in the acute brain injury population. The purpose of this study was to examine the feasibility and safety of inducing ketosis using an enteric ketogenic formulation and determine its impact on intracranial and cerebral perfusion pressures and metabolic parameters.Methods: Prospective interventional Phase II trial of ventilated critically ill patients with acute brain injury administered a ketogen...
Source: Neurological Research - Category: Neurology Tags: Neurol Res Source Type: research
A holo ‐transferrin (holo‐Tf)–based nanoplatform is constructed through in situ growth of MnO2 into holo ‐Tf followed by conjugation of protoporphyrin (ppIX). This nanoplatform (MnO2@Tf ‐ppIX, abbreviated as TMP) can efficiently traverse the blood–brain barrier (BBB), realizing highly specific MR imaging of the glioblastoma region. Under ultrasound (US) irradiation, sonodynamic therapy (SDT) is achieved to evidently suppress the tumor growth. AbstractThe blood –brain barrier (BBB) is the most important obstacle to improving the clinical outcomes of diagnosis and therapy of glioblastoma. Thus, the ...
Source: Small - Category: Nanotechnology Authors: Tags: Full Paper Source Type: research
Conclusions: Pre-injury psychiatric and pre-injury headache/migraine symptoms are risk factors for worse functional and post-concussive outcomes at 3- and 6-months post-mTBI. mTBI patients presenting to acute care should be evaluated for psychiatric and headache/migraine history, with lower thresholds for providing TBI education/resources, surveillance, and follow-up/referrals. Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT01565551. Introduction Traumatic brain injury (TBI) remains a significant cause of morbidity and mortality worldwide. In 2013 ~2.8 million TBI cases were recorded annually i...
Source: Frontiers in Neurology - Category: Neurology Source Type: research
We report a case of RCVS with hidden breast cancer in which ischemic stroke and cortical subarachnoid hemorrhage were observed earlier than vasoconstriction, and there were positive autoantibodies.
Source: Annals of Indian Academy of Neurology - Category: Neurology Authors: Source Type: research
by Michael D. Ehlers, MD, PhD Dr. Ehlers is with Biogen in Cambridge, Massachusetts. Innov Clin Neurosci. 2018;15(3–4):15–16 Funding: No funding was received for the preparation of this article. Disclosures: Dr. Ehlers is an employee and shareholder at Biogen Inc. in Cambridge, Massachusetts. Prominent and expensive failures in Alzheimer’s disease therapies have led to a contagious belief system in some parts of the biopharma industry that neuroscience is just too hard, too risky, and too uncertain. But, might this belief system itself be a residual bias of the past? Close inspection reveals all the signs...
Source: Innovations in Clinical Neuroscience - Category: Neuroscience Authors: Tags: Commentary Current Issue Source Type: research
Conclusions:Pituitary apoplexy occurs when a pituitary tumor, typically macroadenoma, hemorrhages or infarcts resulting in a rapid expansion of the hypophysis and compression of adjacent structures, including the internal carotid arteries (ICA)which can result in cerebral ischemia. Proposed mechanisms of cerebral infarction to date include both direct compression or vasospasm of the ICA. Vasospasm as a cause is proposed to be from either extravasation of blood into the subarachnoid space or release of vasoactive substances by the tumor itself. This matter is still debated in the literature. Emergent recognition and imaging...
Source: Neurology - Category: Neurology Authors: Tags: Cerebrovascular Disease Case Reports II Source Type: research
Conclusions: While pre-mixing tPA does not incur financial risk as drug manufacturers replace unused vials without cost, stroke centers remain wary of wasting the drug. We believe succinct criteria can reduce avoidable tPA waste, allowing health care providers to remain fiscally responsible while ensuring AIS patients are treated as fast as possible.Disclosure: Dr. McCarthy has nothing to disclose. Dr. Caputo has nothing to disclose. Dr. Whaley has received personal compensation for activities with Clinical Data Management/Neurobase and Genentech. Dr. Fanale has received personal compensation for activities with Genentech,...
Source: Neurology - Category: Neurology Authors: Tags: Acute Therapy: IV t-PA Source Type: research
Purpose of Review:: Intracranial pressure (ICP) can be elevated in traumatic brain injury, large artery acute ischemic stroke, intracranial hemorrhage, intracranial neoplasms, and diffuse cerebral disorders such as meningitis, encephalitis, and acute hepatic failure. Raised ICP is also known as intracranial hypertension and is defined as a sustained ICP of greater than 20 mm Hg. Recent Findings:: ICP must be measured through an invasive brain catheter, typically an external ventricular catheter that can drain CSF and measure ICP, or through an intraparenchymal ICP probe. Proper recognition of the clinical signs of elevated...
Source: CONTINUUM - Category: Neurology Tags: Review Articles Source Type: research
CONCLUSIONS: In this retrospective study, every decade increase in age, teaching hospital status and development of complications like hydrocephalus, ischemic stroke, seizures, intracranial abscess and respiratory failure were predictors of poor outcome. Every calendar year increase was a negative predictor of poor outcome. Study Supported by:Disclosure: Dr. Dharaiya has nothing to disclose. Dr. Modi has nothing to disclose. Dr. Maraka has nothing to disclose.
Source: Neurology - Category: Neurology Authors: Tags: Neuroepidemiology: Headache, Global Health, and Infectious Disease Source Type: research
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