An elderly lady, 80 years of age, with a past medical history of high blood pressure was admitted to the emergency department after sudden onset of dizziness and binocular diplopia. Dizziness improved in the next 24 hours but diplopia did not change. She was discharged from the hospital with medical treatment. She was initially checked two months later because of persistence of binocular diplop...

Marc W. Halterman, MD, PhD G. Edward Vates, MD, PhD Garrett Riggs, MD, PhD Idiopathic aqueductal stenosis (AS) may account for up to 59% of cases presenting with triventricular noncommunicating hydrocephalus.1 The clinical presentations associated with triventricular hydrocephalus differ depending on age at onset and the acuity of obstruction. Acute syndromes include Parinaud’s syndrome (vertic...

To cite: Man BL, Chi MS, Fu YP. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/bcr-2014207240 DESCRIPTION An 84-year-old man with a history of hypertension, diabetes mellitus and ischaemic heart disease, was admitted for sudden onset binocular diplopia and unsteady gait. Physical examination showed primary gaze exotropia of both eyes (figure 1), bilateral internuclea...

Failure of brainstem supranuclear centers for saccadic eye movements results in the clinical presence of a brainstem-mediated supranuclear saccadic gaze palsy (SGP), which is manifested as slowing of saccades with or without range of motion limitation of eye movements and as loss of quick phases of optokinetic nystagmus. Limitation in the range of motion of eye movements is typically worse with...

Progressive supranuclear palsy is a sporadic and progressive neurodegenerative disease, most often presenting as a symmetric, akinetic-rigid syndrome with postural instability, vertical supranuclear gaze palsy and frontal lobe deficits. It belongs to the family of tauopathies and involves both cortical and subcortical structures. Although the exact pathophysiology is not yet fully understood, s...

A 27 year old woman with mitral valve prolapse presented with somnolence, bilateral Babinski signs, and grasp reflexes. As somnolence cleared, vertical gaze palsy and Korsakoffian memory deficit were apparent. Initial CT scan was normal, but NMR scan 24 hours after the onset of symptoms revealed prolonged T2 relaxation in medial thalami bilaterally, facilitating diagnosis of bithalamic infarcti...

Background and aim: Considering the widespread development of implants in dental treatment plans, linear measurements on panoramic radiography are of especial importance. In the present study we investigated the effect of head misalignment up to 15° around vertical and horizontal axes on the magnification rate of digital panoramic radiography in each part of upper and lower jaws. Materia...

Dear Sir, We describe a patient with progressive locked-in syndrome due to a giant interpeduncular basilar aneurysm that initially underwent coiling and eventually clipping. The case is unusual because the locked-in syndrome was caused by severe midbrain compression rather than an ischemic infarction of the basis pontis, had a gradual rather than abrupt onset and was accompanied by vertical rat...

Fig. 1. A 59-year-old female with parkinsonian multiple system atrophy (MSA-P) with no vertical supranuclear gaze-palsy. A T2weighted image suggests the lateral margin of the posterior tegmentum of the midbrain is ‰at or slightly concave. Note that both superior and inferior colliculi are present in the same plane. Fig. 2. A midsagittal T1-weighted image of the same patient. The horizontal line...