Teaching NeuroImages: Sucking candy sign in Bell palsy

Teaching NeuroImages: "Penguin" or "hummingbird" sign and midbrain atrophy in progressive supranuclear palsy.

Jerome J. Graber, MD, MPH Robert Staudinger, MD, FAAN An 82-year-old man presented to us with a 2-year history of progressive difficulty walking. On examination, he had bradykinesia, bradyphrenia, axial rigidity without appendicular rigidity, cogwheeling, or tremor, and restriction of upward and downward gaze. Imaging revealed prominent midbrain atrophy without pontine atrophy, referred to as t...

Teaching NeuroImages: herpes zoster ophthalmicus-related oculomotor palsy accompanied by Hutchinson sign.

A 51-year-old woman presented with acute diplopia. Findings include right ptosis, a dilated, unreactive pupil, and impaired adduction and vertical ductions (figure 1). A skin lesion was noted on the right tip of the nose, residual from a vesicular rash over the right forehead 3 weeks earlier (figure 1). MRI demonstrated enhancement of the cisternal third nerve, obviating the need for angiograph...

Teaching NeuroImages: awakening ptosis (unilateral hypnopompic eyelid palsy).

A healthy 68-year-old woman presented with 2 years of recurrent episodes of right ptosis, constantly present after waking from sleep (figure 1). Clinical examination, brain MRI, EMG, and polysomnography were unremarkable (figure 2). In particular, there was no cranial nerve impairment. Few cases of idiopathic ptosis on awakening have been described, and they have been attributed to eyelid openi...

Teaching neuroimages: MRI "target sign" and neurofibromatosis type 1.

A 9-year-old girl presented with a firm occipital swelling. She had multiple café-au-lait lesions without other clinical features or family history of neurofibromatosis type 1 (NF1). MRI showed subcutaneous soft tissue mass in the left occipitotemporal region with “target sign” suggestive of plexiform neurofibroma (figure 1). There were supra and infratentorial T2-weighted hyperintense lesions,...

Teaching NeuroImages: Spontaneous spinal epidural hematoma with spot sign positivity.