Neurological manifestations in a patient with visceral leishmaniasis.

Accepted 21 January 1998 A 20-year-old man with visceral leishmaniasis receiving sodium stibogluconate therapy presented with left earache, skin eruptions over the left ear and side of the neck, inability to close the left eye, dribbling of saliva through the left side of the mouth, facial asymmetry with slurring ofspeech and hearing impairment (left ear) for two weeks. Four days later he also experienced marked unsteadiness of gait and falling towards the left while walking. Eruptions gradually subsided, pain decreased, but scars were left (figure). On examination, the patient had scanning type of dysarthia and left-sided gaze-evoked nystagmus. Corneal reflex on the left side was absent. There was lower motor neuron type of facial palsy along with loss of taste over the left half of the anterior two thirds of the tongue. The patient had left-sided neural deafness and marked gait ataxia. Heel-shin test and finger-nose test on the left side were markedly impaired. All superficial reflexes were present and plantars were flexor. Haematological, serum biochemical parameters and urinalysis were normal. Chest X-ray, electrocardiogram, computed tomography and magnetic resonance imaging of the head were also normal.