71-year-old Man with Nystagmus and Oscillpsia

Slides:

Advertisements

Similar presentations

Teaching NeuroImages Neurology Resident and Fellow Section © 2013 American Academy of Neurology Neonatal Parechovirus Encephalitis: Typical MRI findings.

Advertisements

A 41 year old African patient with „multifocal neurology“ Teaching NeuroImages Neurology Resident and Fellow Section © 2013 American Academy of Neurology.

A 52-year old man with recently diagnosed HIV infection with irregular shaking of his hand Teaching NeuroImages Neurology Resident and Fellow Section ©

A 62-year-old man presented with mild left hemiparesis, headache and blurred vision of his right eye Teaching NeuroImages Neurology Resident and Fellow.

A 62-year-old man with progressive action tremor and a 74-year-old man with progressive ataxia Teaching NeuroImages Neurology Resident and Fellow Section.

A 48-year-old man with ptosis and limitation of elevation in the left eye © 2014 American Academy of Neurology Teaching NeuroImages Neurology Resident.

Teaching NeuroImages Neurology Resident and Fellow Section © 2013 American Academy of Neurology.

Muscle cramps and a raised creatine kinase. Teaching NeuroImages Neurology Resident and Fellow Section © 2013 American Academy of Neurology.

A patient with red dot on the forehead A 32-year old woman presented with red dot on her forehead and eyelid ecchymosis Teaching NeuroImages Neurology.

A 30 year old man with sub-acute ataxia Teaching NeuroImages Neurology Resident and Fellow Section © 2014 American Academy of Neurology.

Neurology Resident and Fellow Section 40 year old woman with left arm pain, numbness, and weakness Teaching NeuroImages © 2013 American Academy of Neurology.

A 43-year-old man with decreased consciousness Teaching NeuroImages Neurology Resident and Fellow Section © 2014 American Academy of Neurology.

A 17-year-old girl with encephalomyelitis Teaching NeuroImages Neurology Resident and Fellow Section © 2015 American Academy of Neurology.

A 50 year old man with progressive tetraparesis and blindness Teaching NeuroImages Neurology Resident and Fellow Section © 2013 American Academy of Neurology.

A 53-year-old man with abrupt hearing loss Teaching NeuroImages Neurology Resident and Fellow Section © 2013 American Academy of Neurology.

Teaching NeuroImages Neurology Resident and Fellow Section © 2013 American Academy of Neurology A dangerous case of orthostatic headache.

47-year-old with progressive upper limb weakness Teaching NeuroImages Neurology Resident and Fellow Section © 2014 American Academy of Neurology.

Teaching NeuroImages Neurology Resident and Fellow Section © 2013 American Academy of Neurology An unusual cause of conus medullaris syndrome.

A 21-year-old man with rapidly deteriorating somnolence Neurology Resident and Fellow Section © 2013 American Academy of Neurology.

Teaching NeuroImages Neurology Resident and Fellow Section © 2013 American Academy of Neurology Cerebral White Matter Involvement in a Patient with Bilateral.

A 30-year male with cognitive decline and unsteady gait Teaching NeuroImages Neurology Resident and Fellow Section © 2013 American Academy of Neurology.

A 39-year old man with facial diplegia Teaching NeuroImages Neurology Resident and Fellow Section Campbell J, et al © 2013 American Academy of Neurology.

Teaching NeuroImages Neurology Resident and Fellow Section © 2014 American Academy of Neurology A 23 month old full term male with seizures.

68 year old man with aphasia and facial droop © 2014 American Academy of Neurology Teaching NeuroImages Neurology Resident and Fellow Section.

A 22 years old man with slow movements and mounding phenomenon © 2013 American Academy of Neurology Teaching NeuroImages Neurology Resident and Fellow.

67-old man with 45-min onset left hemiparesis Teaching NeuroImages Neurology Resident and Fellow Section © 2015 American Academy of Neurology.

Teaching NeuroImages Neurology Resident and Fellow Section A 32-year-old woman presented with headaches, ataxia, diplopia © 2015 American Academy of Neurology.

A 21-year-old male with rapidly- progressive cortical visual loss Teaching NeuroImages Neurology Resident and Fellow Section © 2015 American Academy of.

A 4 Year Old Boy With Proptosis of Left Eye Teaching NeuroImages Neurology Resident and Fellow Section © 2014 American Academy of Neurology.

6-year-old boy with progressive neurologic decline Teaching NeuroImages Neurology Resident and Fellow Section © 2015 American Academy of Neurology.

57 year-old man with confusion Teaching NeuroImages Neurology Resident and Fellow Section © 2015 American Academy of Neurology.

A 35-year-old patient with motor aphasia Teaching NeuroImages Neurology Resident and Fellow Section © 2013 American Academy of Neurology.

Deschamps et al. TEACHING NEUROIMAGES NEUROLOGY RESIDENT AND FELLOW SECTION A 54-year-old man with eyelid swelling and diplopia.

Patient with painful ophthalmoplegia after traffic accidents

Neurology Resident and Fellow Section

Teaching NeuroImages Neurology Resident and Fellow Section

Neurology Resident and Fellow Section

Teaching Video NeuroImages Neurology Resident and Fellow Section

A 55 year-old with lung cancer and leg numbness

Neurology Resident and Fellow Section

A 57-year-old woman with seizures and coma

Neurology Resident and Fellow Section

A 41-year-old man with progressive quadriparesis

Autoimmune Encephalitis

A 54-year old woman with subacute encephalopathy

Neurology Resident and Fellow Section

A 22 year old woman with progressive vision loss

Neurology Resident and Fellow Section

Resident and Fellow Section

A 30 year old man with headaches, imbalance and aphasia

A 29-year-old HIV infected man with right eye-lid ptosis and diplopia

A 6 years old girl with progressive strabismus and vision loss

68-year-old patient with memory impairment

A 7 month old boy with Glutaric Aciduria and flexor spells

Teaching NeuroImages Neurology Resident and Fellow Section

Anti-Hu encephalitis. Anti-Hu encephalitis. A 68-year-old man with chronic obstructive pulmonary disease presented with gradually worsening memory deficits.

A 21 year old woman with frequent vomiting

A 50-year-old man with progressive dysautonomia and leg stiffness

Neurology Resident and Fellow Section

A 74-year old woman with progressive amnesia

Figure 2 Binding of the patient's IgG to Purkinje cells is inhibited by pretreatment of rat tissue with anti-VGCC antibodies, confirming specificity of.

20 year old man with multiple strokes territories

Figure 1 VGCC antibody uptake in cerebellar slice culture

Figure Disease course and neuropathology of CASPR2 encephalitis(A) Summary of the most important changes during the disease course. Disease course and.

Figure 2 Brain MRI at 1 year of age

Images from the case of an 8-year-old female patient with complex I mitochondrial disease, which was diagnosed when the patient was older than 3 years.

Teaching NeuroImages Neurology Resident and Fellow Section

Anti-voltage-gated calcium channel cerebellitis.

A 3-year-old boy with increased head circumference

A treatable case of subacute encephalopathy

Presentation transcript:

71-year-old Man with Nystagmus and Oscillpsia Teaching NeuroImages Neurology Resident and Fellow section © 2016 American Academy of Neurology

Vignette 71-year-old Caucasian man with a strong smoking history, without any known malignancy, presented with an eleven-month history of initial left monocular followed by binocular elliptical nystagmus and oscillopsia . Physical examination showed binocular elliptical nystagmus that did not improve with fixation (Video 1) and MRI brain revealed extensive periventricular T2- weighted signal changes also involving the corpus callosum (Image 1) Cerebrospinal fluid (CSF) revealed protein of 102 mg/dL; glucose, white blood cell count, cytology and high-volume flow cytometry were normal Anti-Neuronal-type Voltage-Gated Potassium Channel (VGKC) and anti-P/Q-type Voltage-Gated Calcium Channel (VGCC) antibodies titers were elevated in serum Mistry et al. © 2016 American Academy of Neurology

Imaging Image 1. Extensive T2 FLAIR signal changes in the periventricular area, splenium, and genu of corpus callosum that is non enhancing. Mistry et al. © 2016 American Academy of Neurology

Imaging Video 1: Binocular elliptical nystagmus that did not improve with fixation Mistry et al. © 2016 American Academy of Neurology

P/Q-Type Voltage-gated Calcium Channel associated Paraneoplastic Elliptical Nystagmus The patient was treated with carbamazepine(for symptomatic relief) followed by high dose intravenous methylprednisolone, resulting in a moderate improvement. No malignancy was found on PET scan and CT scan of his chest, abdomen, and pelvis. Anti-VGCC antibodies have been implicated in paraneoplastic nystagmus and small cell lung cancer is the most common associated malignancy.1,2 An underlying malignancy may or may not be present at the time of diagnosis; therefor, close follow up after a comprehensive workup is often required. Immunomodulatory therapies such as steroids, intravenous immunoglobulin, plasma exchange, and rituximab have been tried, but they often do not provide a complete resolution of the symptoms.2 References: 1. Ko MW, Dalmau J, Galetta SL. Neuro-ophthalmologic manifestations of paraneoplastic syndromes. J Neuroophthalmol. 2008;28(1):58-68. 2. Bekircan-Kurt CE, Derle Ciftci E, Kurne AT, Anlar B. Voltage gated calcium channel antibody-related neurological diseases. World J Clin Cases. 2015;3(3):293-300. Mistry et al. © 2016 American Academy of Neurology