Research in Vestibular Science

Case Report

Fourth Nerve Paresis plus Crossed Horner Syndrome in Acute Leukemia: Sumin Kim, Sung-Hee Kim; Res Vestib Sci. 2022;21(3):86-88. Published online September 15, 2022; DOI: https://doi.org/10.21790/rvs.2022.21.3.86

Abstract PDF: A 29-year-old patient with diplopia showed a unilateral fourth nerve palsy combined with a Horner syndrome on the opposite side. Magnetic resonance images disclosed a focal hemorrhage in the left dorsal midbrain, affecting the nucleus of the fourth nerve and adjacent oculosympathetic fibers. Further evaluations including a bone marrow biopsy confirmed acute lymphoblastic leukemia. The combination of ocular motor and oculosympathetic palsy has a distinct localizing value. Fourth nerve palsy ipsilateral to Horner syndrome locates lesion in the cavernous sinus, while contralateral fourth nerve palsy locates the lesion in the midbrain.

Symposium I

Ataxia and Diplopia: Jae-Deuk Seo, In Soo Moon, Kwang-Dong Choi; Res Vestib Sci. 2013;12:S31-S40. Published online June 1, 2013

Abstract PDF: Ataxia is a neurological sign consisting of lack of voluntary coordination of muscle movements, which may result from abnormalities in different parts of the nervous system including the cerebellum and its connecting pathway, proprioceptive sensory pathway, and vestibular system. In the diagnosis of disorders characterized by cerebellar ataxia, the mode of onset, rate of development, and degree of permanence of the ataxia are of particular importance. In adults, paraneoplastic and demyelinating cases account for the largest proportion of subacute onset, and hereditary forms are the usual cause of very slowly progressive and chronic ones. The last category of genetic ataxias now constitute a large and heterogeneous group for which the basis has been established in most cases. Misalignment of the visual axes-strabismus-causes the two images of a seen object to fall on noncorresponding areas of the two retinas, which usually causes diplopia, the sensation of seeing an object at two different locations in space. Accurate diagnosis of diplopia and strabismus require detailed history on the symptomatology and ocular motor examination consisting of assessment of the range of eye movements, subjective diplopia testing, and cover and alternate cover tests.

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