A CASE OF ACUTE ONSET NEUROPSYCHOLOGICAL DEFICIT AND VERTICAL GAZE PALSY

O. K. Jumma, T. Majeed. Department of Neurology, Royal Preston Hospital, Preston, UK

A case of acute onset neuropsychological deficit and vertical gaze palsy, a 61-year-old woman with paroxysmal atrial fibrillation, hypertension and migraine presented with sudden onset of flashing lights, severe headache, double vision, and subsequently became unresponsive requiring intubation and intensive care unit admission. Initial brain CT to exclude subarachnoid haemorrhage was normal, but a repeat scan 24 h later demonstrated ischemic lesions in right thalamus and internal capsule. Three days later, she was extubated but noted to be confused. She was drowsy, sleepy and amnesic. Eye examination revealed impairment of vertical eyes movements. The rest of cranial nerves were normal. She had normal upper limbs examination. In the lower limbs she had brisk reflexes, mild gait ataxia and up going plantars. Blood tests and CSF examination were normal. Brain (MRI) demonstrated bilateral paramedian thalamic infarction. CT-angiography showed normal carotid arteries. She was eventually transferred to neurorehabilitation unit, where she continued to suffer from hypersomnolense and vertical gaze palsy. A repeat brain MRI did not show significant changes. Detailed neuropsychological assessment demonstrated profound cognitive impairment.

In conclusion, it is important to consider this type of ischemic infarction in the differential diagnosis of patients with recurrent episodes of unresponsiveness, cognitive impairment and gaze palsy.

Email: odaijumma@yahoo.co.uk

A NEW TIC-BORNE MYELOPATHY?

J. D. Isaacs, M. Adams, A. J. Lees. National Hospital for Neurology and Neurosurgery, London, UK

We describe a 20-year-old man with intractable Tourette’s syndrome with onset at age 6. Prominent among his motor features are violent hyperextension and lateral flexion axial tics. Since the age of 17 he has had a progressive spastic paraparesis with posterior column signs. Spinal MRI demonstrates a highly unusual picture with multiple focal T2 hyperintense lesions in the posterior spinal cord, without evidence of cord compression. Extensive …