In multiple sclerosis (MS), nystagmus or internuclear ophthalmoplegia (INO) are the usual ocular motor dysfunctions. However, in patients with focal brainstem lesions, other rare manifestations may be observed, such a...In multiple sclerosis (MS), nystagmus or internuclear ophthalmoplegia (INO) are the usual ocular motor dysfunctions. However, in patients with focal brainstem lesions, other rare manifestations may be observed, such as an isolated ocular motor nerve palsy or complex ocular motor disturbances. We report five MS patients with unusual ocular motor disturbances (bilateral third nerve palsy [n=2], opsoclonus, Horner’ s syndrome and one and-a-half syndrome). We discuss possible correlations between clinical disturbances and MRI abnormalities. Patients were seen in two MS centres. They had a confirmed diagnosis of MS and underwent a brain MRI and a complete neuro-ophthalmological work-up. In one case (opsoclonus), ocular motor manifestations were the first manifestation of MS. In the other four cases they occurred 3 months (Horner syndrome), 6 years and 12 years (bilateral third nerve palsy) and 2 years (one-anda-half syndrome) after the disease onset, respectively. Four out of five patients were still in a relapsing-remitting form of MS. In the opsoclonus case, there was no evidence of a brainstem lesion. A gadolinium-enhanced lesion (2 cases) or a new T2-weighted lesion located in the brainstem correlated with the clinical presentation. All patients completely or partially recovered after corticosteroid infusions. Our study shows some rare or previously undescribed complex ocular motor symptoms in MS.展开更多
Introduction. Serological confirmation of an infectious acute myelitis injury is difficult to confirm as it is sometimes due to a post-infectious etiology. Objectives. The aim of this study was to define the clinical,...Introduction. Serological confirmation of an infectious acute myelitis injury is difficult to confirm as it is sometimes due to a post-infectious etiology. Objectives. The aim of this study was to define the clinical, biological and pr ognostic patterns of infectious myelitis. Patients and methods. This retrospecti ve study included 153 subjects hospitalized in the department of neurology betwe en 1993 and 2002 for treatment of a noncompressive acute myelopathy. Biological confirmation of recent infection was obtained in 12 patients (8 p. 100). Results . An infectious syndrome, beginning prior to the neurological symptoms, was foun d in 67 percent of patients. The clinical symptoms were severe with loss of sens oromotor and sphincter functions and ascending spinal cord dysfunction (acute tr ansverse myelopathy). Spinal cord MRI showed extended centromedullar high intens ity signals with rapid and complete regression. CSF analysis cell count was abov e 30/mm3 with hyperproteinorachia, in 75 percent and 58 percent of patients resp ectively. CSF electrophoresis did not detect oligoclonal bands. Clinical outcome was good in all patients except one, however sphincter disorders recovered slow ly. Discussion. Our study illustrates a stereotypical clinical, biological and p rognostic pattern for infectious acute myelitis. These findings contribute signi ficantly to therapeutic decision making and establishing prognosis at the initia l phase of acute myelopathy.展开更多
Introduction. We report a case of bilateral third cranial nerve palsy in a pat ient with a secondary progressive multiple sclerosis. Observation. MRI revealed a large hyperintense lesion in T2-weighted images in the m...Introduction. We report a case of bilateral third cranial nerve palsy in a pat ient with a secondary progressive multiple sclerosis. Observation. MRI revealed a large hyperintense lesion in T2-weighted images in the mesencephalic area. Th e clinical and radiological outcome was good after intravenous methylprednisolon e. The oculomotor signs were probably caused by this mesencephalic lesion. Concl usion. This case of bilateral third cranial nerve palsy is, to our knowledge, th e first one occurring in a patient with multiple sclerosis.展开更多
文摘In multiple sclerosis (MS), nystagmus or internuclear ophthalmoplegia (INO) are the usual ocular motor dysfunctions. However, in patients with focal brainstem lesions, other rare manifestations may be observed, such as an isolated ocular motor nerve palsy or complex ocular motor disturbances. We report five MS patients with unusual ocular motor disturbances (bilateral third nerve palsy [n=2], opsoclonus, Horner’ s syndrome and one and-a-half syndrome). We discuss possible correlations between clinical disturbances and MRI abnormalities. Patients were seen in two MS centres. They had a confirmed diagnosis of MS and underwent a brain MRI and a complete neuro-ophthalmological work-up. In one case (opsoclonus), ocular motor manifestations were the first manifestation of MS. In the other four cases they occurred 3 months (Horner syndrome), 6 years and 12 years (bilateral third nerve palsy) and 2 years (one-anda-half syndrome) after the disease onset, respectively. Four out of five patients were still in a relapsing-remitting form of MS. In the opsoclonus case, there was no evidence of a brainstem lesion. A gadolinium-enhanced lesion (2 cases) or a new T2-weighted lesion located in the brainstem correlated with the clinical presentation. All patients completely or partially recovered after corticosteroid infusions. Our study shows some rare or previously undescribed complex ocular motor symptoms in MS.
文摘Introduction. Serological confirmation of an infectious acute myelitis injury is difficult to confirm as it is sometimes due to a post-infectious etiology. Objectives. The aim of this study was to define the clinical, biological and pr ognostic patterns of infectious myelitis. Patients and methods. This retrospecti ve study included 153 subjects hospitalized in the department of neurology betwe en 1993 and 2002 for treatment of a noncompressive acute myelopathy. Biological confirmation of recent infection was obtained in 12 patients (8 p. 100). Results . An infectious syndrome, beginning prior to the neurological symptoms, was foun d in 67 percent of patients. The clinical symptoms were severe with loss of sens oromotor and sphincter functions and ascending spinal cord dysfunction (acute tr ansverse myelopathy). Spinal cord MRI showed extended centromedullar high intens ity signals with rapid and complete regression. CSF analysis cell count was abov e 30/mm3 with hyperproteinorachia, in 75 percent and 58 percent of patients resp ectively. CSF electrophoresis did not detect oligoclonal bands. Clinical outcome was good in all patients except one, however sphincter disorders recovered slow ly. Discussion. Our study illustrates a stereotypical clinical, biological and p rognostic pattern for infectious acute myelitis. These findings contribute signi ficantly to therapeutic decision making and establishing prognosis at the initia l phase of acute myelopathy.
文摘Introduction. We report a case of bilateral third cranial nerve palsy in a pat ient with a secondary progressive multiple sclerosis. Observation. MRI revealed a large hyperintense lesion in T2-weighted images in the mesencephalic area. Th e clinical and radiological outcome was good after intravenous methylprednisolon e. The oculomotor signs were probably caused by this mesencephalic lesion. Concl usion. This case of bilateral third cranial nerve palsy is, to our knowledge, th e first one occurring in a patient with multiple sclerosis.
