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A Case of Creutzfeldt-Jakob Disease Presenting Mainly with Abnormal Eye Movements
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Yeo Jeong Kang, Jun Hyun Kim, Tae Eun Kim, Sun Ah Park, Tae Kyeong Lee
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Res Vestib Sci. 2014;13(2):53-56.
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- Creutzfeldt-Jakob disease (CJD) is a human prion disease with rapidly progressive neurodegeneration. The major clinical manifestations of CJD include mental deterioration, myoclonus, cerebellar dysfunction, and neuro-ophthalmic symptoms and signs. However, abnormal eye movements as an early sign of CJD are rare. We report a 49-year-old man with periodic alternating nystagmus in early disease course.
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A Case of Lateral Medullary Syndrome with Ipsilesional Nystagmus due to Intramedullary Hemorrhage
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Ki Bum Sung, Ji Yun Park, Sun Ah Park, Tae Kyeong Lee
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Res Vestib Sci. 2009;8(1):52-55.
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- We report a rare case of primary dorsal medullary hemorrhage showing lateral medullary syndrome with ipsilesional nystagmus. A 41-year woman, presented with the first degree horizontal vestibular nystagmus and ocular tilt reaction to the left in lateral medullary hemorrhagic lesion. Primary medullary hemorrhage is rare and details of the abnormal eye movement in the lesion have never been described well. While most of the reported vestibular nystagmus in the lateral medullary infarction was contralesional., the nystagmus in this case was ipsilesional. This ipsilesional beating of the nystagmus might be explained that either destruction of the rostral part of vestibular nuclei or irritative effect of blood to vestibular nuclei is responsible. In addition, ocular tilt reaction (OTR) can be more important in deciding the side of the lesion in medullary hemorrhage.
Key Words: Lateral medullary syndrome; Medulla oblongata, Hemorrhage; Nystagmus, Pathologic
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3-D Model of The Oculomotor Fascicular Arrangement Within The Midbrain Using Brain MRI
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Jeong Ho Park, Du Shin Jeong, Sun Ah Park, Tae Kyeong Lee, Ki Bum Sung
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J Korean Bal Soc. 2008;7(1):22-32.
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- Background and Purpose: The oculomotor nerve fascicles arise along its entire length and sweep ventrally to exit the midbrain at the medial edge of the crus cerebri. A rostro-caudal topography among the fascicular fibers is relatively well established. There are, however, some controversies whether medio-lateral topography also exists.
Methods: We retrospectively reviewed the clinical records and MRI of the 8 patients showing isolated oculomotor nerve palsy due to midbrain infarction. Brain MRI was performed using a 1.5-T magnet with 2mm thickness and 0.1 mm slice interval. The anterior-posterior axis(X) was defined as the midline crossing the center of the cerebral aqueduct and the medio-lateral axis(Y) as the line crossing the same point. For rostro-caudal measurement, the intercommissural line was used as base line of the Z axis. The location of the lesions was defined by measuring actual distance of the margins of the lesions in millimeter from each axis; anterior, right, and caudal direction was defined as positive values in X, Y and Z coordinates, respectively.
Results: The mean values and range of the X, Y and Z are as follows: X=7.56±4.34, 1≤X≤15; Y=3.43±1.37, 0≤Y≤6; Z=6.51±3.91, 0≤Z≤12.5.
Conclusions: The distribution of all the MRI lesions was 0≤|Y|≤6 (mm), 0≤|Z|≤12.5 (mm) in mediolateral and rostrocaudal direction respectively, which is almost the same as the previously reported divergent range of the oculomotor fascicles in midbrain tegmentum. We suggest that our method of three dimensional measurements of the MRI lesion in midbrain tegmentum could be a useful tool for the study of oculomotor fascicular arrangement.
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A Case of Isolated Unilateral Abducens Nerve Palsy Caused by Clival Metastasis from Rectal Cancer
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Won Hee Chung, Jeong Ho Park, Sun Ah Park, Ki Bum Sung
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J Korean Bal Soc. 2006;5(1):78-80.
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- A wide variety of abnormalities, both primary to the nerve itself and secondarily involving the nerve, can cause isolated abducens nerve palsy. Skull base lesions are also regarded as possible causes of isolated abducens nerve palsy but clival metastasis from systemic malignancy has rarely been reported. We report a case of isolated abducens nerve palsy caused by clival metastasis from rectal cancer.
Key Words : Abducens nerve palsy, Metastasis, Skull base, Rectal neoplasm
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Isolated Abducens Nerve Palsy Caused by De Novo Pontine Cavernous Angioma
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Jeong Ho Park, Won Hee Chung, Sun Ah Park, Ki Bum Sung
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J Korean Bal Soc. 2006;5(1):70-73.
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- Cavernous angiomas are considered to be congenital in origin. Patients under age of 14 years usually does not require imaging because they are likely to have a benign abducens nerve palsy, unless they develop additional signs or symptoms of neurologic disease during observation. Here we report a case of an isolated abducens nerve palsy caused by overt hemorrhage from de novo formation of cavernous angioma in the pons. Cavernous angiomas of the brain stem should be considered as a possible cause of isolated abducens nerve palsy in young adult and MRI, including gradient-echo sequences should be performed.
Key Words : Cavernous angioma, Abducens nerve palsy
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A Case of Vogt-Koyanagi-Harada syndrome presenting initially with recurrent vertigo
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Tae Kyeong Lee, Sang Won Nam, Sun Ah Park, Ki Bum Sung
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J Korean Bal Soc. 2003;2(2):234-236.
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- Besides meningism, dizziness has also been frequently reported as a neurologic manifestation of Vogt-Koyanagi-Harada(VKH) syndrome. These neurotologic symptoms usually develop just before or after ocular involvement. We report the patient with VKH syndrome who showed recurrent peripheral vertigo. The characteristic opthalmological symptoms developed later in this case.
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Neuro-Behcet's Disease Presenting with Foville Syndrome - A Case Report -
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Won Hee Chung, Sun Ah Park, Tae Kyeong Lee, Ki Bum Sung
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J Korean Bal Soc. 2003;2(1):129-132.
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- A Foville syndrome is rare. A 46-year-old man with a 3-year history of Behcet's disease presented with a right facial palsy and a limitation in the rightward movements of the eyes. On neurologic examination, there was no movement of eyes in the right hemifield during all kinds of eye movements, including saccade, smooth pursuit, vestibulo-ocular reflex, and optokinetic nystagmus. However, all the eye movements were normal in the left hemifiled except for slowed saccades toward the right. Additional features were right infranuclear facial paresis and extensor plantar response on left side. Brain MRI revealed high signal intensity lesions in the right pons both in the dorsal tegmentum and in the basis. Neurological signs resolved gradually with steroid treatment. Different clinical features between abducens nucleus syndrome and paramedian pontine reticular formation syndrome are briefly discussed. To the authors' knowledge, this is the first case report of a Foville syndrome caused by neuro-Behcet's disease.
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