دورية أكاديمية
A rare case of concomitant sicca keratopathy and ipsilateral central facial palsy in Wallenberg's dorsolateral medullary syndrome
| العنوان: | A rare case of concomitant sicca keratopathy and ipsilateral central facial palsy in Wallenberg's dorsolateral medullary syndrome |
|---|---|
| المؤلفون: | De Bruyn, D, Van Aken, E, Herman, K |
| المصدر: | GMS Ophthalmology Cases; VOL: 7; DOC08 /20170307/ |
| بيانات النشر: | German Medical Science GMS Publishing House; Düsseldorf |
| سنة النشر: | 2017 |
| المجموعة: | GMS e-journal - German Medical Science (Association of the Scientific Medical Societies in Germany) |
| مصطلحات موضوعية: | central facial palsy, supranuclear facial palsy, sicca keratopathy, superior salivatory nucleus, medulla oblongata, dorsolateral medullary infarction, Wallenberg's syndrome, subclavian steal syndrome, ddc: 610 |
| الوصف: | Objective: To describe a patient with a right-sided supranuclear facial palsy and concomitant sicca keratopathy of the right eye following right-sided dorsolateral medullary infarction. Methods: Our patient underwent a complete ophthalmologic and neurologic examination including biomicroscopy, fundus examination, cranial nerve examination, Shirmer I test, and magnetic resonance imaging of the brain.Results: A 61-year-old woman presented in emergency with a central facial nerve palsy on the right side and truncal ataxia. Neurologic assessment revealed a concurrent dysphagia, dysarthria, hypoesthesia of the right face, and weakness of the right upper limb. Magnetic resonance imaging of the brain showed an old left-sided cerebellar infarction, but a recent ischemic infarction at the level of the right dorsolateral medulla oblongata was the cause of our patient's current problems. One month after diagnosis of the right-sided dorsolateral medullary syndrome, there were complaints of ocular irritation and a diminished visual acuity in the right eye. Biomicroscopy showed a sicca keratopathy with nearly complete absence of tear secretion on the Shirmer I test, but with normal eye closure and preserved corneal reflexes and sensitivity.Conclusion: A dorsolateral medullary syndrome can have a variable expression in symptomatology. Our case is special because of the combination of an ipsilateral supranuclear facial palsy with normal upper facial muscle function together with an ipsilateral sicca keratopathy as a result of a nearly absent tear secretion. We hypothesized that the mechanism underlying the patient's sicca keratopathy ipsilateral to the supranuclear facial palsy involved the superior salivatory nucleus, which is situated in the caudal pons inferiorly of the motor facial nucleus and is most probably affected by a superior extension of the infarcted area in the right medulla oblongata. |
| نوع الوثيقة: | article in journal/newspaper |
| اللغة: | English |
| العلاقة: | Day GS, Swartz RH, Chenkin J, Shamji AI, Frost DW. Lateral medullary syndrome: a diagnostic approach illustrated through case presentation and literature review. CJEM. 2014 Mar;16(2):164-70. DOI:10.2310/8000.2013.131059; Forrester J, Dick A, McMenamin P, Roberts F. Cranial nerves associated with the eye and orbit. In: The Eye. Basic sciences in practice. 3rd ed. Philadelphia: Saunders Elsevier; 2008. p. 82-3.; Hipps WM, Wilhelmus KR. Persistent visual loss from neurotrophic corneal ulceration after dorsolateral medullary infarction (Wallenberg syndrome). J Neuroophthalmol. 2004 Dec;24(4):345-6. DOI:10.1097/00041327-200412000-00015; Kargiotis O, Siahos S, Safouris A, Feleskouras A, Magoufis G, Tsivgoulis G. Subclavian Steal Syndrome with or without Arterial Stenosis: A Review. J Neuroimaging. 2016 Sep;26(5):473-80. DOI:10.1111/jon.12371; Liu G, Volpe N, Galetta S. Eyelid and facial nerve disorders. In: Neuro-Ophthalmology. Diagnosis and management. 2nd ed. Philadelphia: WB Saunders; 2001. p. 464-70.; Louis DW, Dholakia N, Raymond MJ. Wallenberg Syndrome with Associated Motor Weakness in a Two-Week-Postpartum Female. Case Rep Neurol. 2015 Sep-Dec;7(3):186-90. DOI:10.1159/000440712; Maeshima S, Tsunoda T, Okamoto S, Ozeki Y, Sonoda S. Alternating Hemiplegia with Ipsilateral Supranuclear Facial Palsy and Abducens Nerve Palsy Caused by Pontine Infarction. Intern Med. 2016;55(15):2073-5. DOI:10.2169/internalmedicine.55.6603; Ogawa K, Suzuki Y, Oishi M, Kamei S. Clinical study of 46 patients with lateral medullary infarction. J Stroke Cerebrovasc Dis. 2015 May;24(5):1065-74. DOI:10.1016/j.jstrokecerebrovasdis.2015.01.006; Nervi craniales. In: Putz R, Pabst R, editors. Sobotta Atlas of human anatomy. Volume 1. 3rd ed. Houten: Bohn Stafleu van Loghum; 2006. p. 300-1.; Whitwell J. Role of the sympathetic in lacrimal secretion. Br J Ophthalmol. 1961 Jun;45(6):439-45.; Wu S, Li N, Xia F, Sidlauskas K, Lin X, Qian Y, Gao W, Zhang Q. Neurotrophic keratopathy due to dorsolateral medullary infarction (Wallenberg syndrome): case report and literature review. BMC Neurol. 2014 Dec;14:231. DOI:10.1186/s12883-014-0231-y; http://dx.doi.org/10.3205/oc000059Test; http://nbn-resolving.de/urn:nbn:de:0183-oc0000592Test; http://www.egms.de/en/journals/oc/2017-7/oc000059.shtmlTest |
| DOI: | 10.3205/oc000059 |
| الإتاحة: | https://doi.org/10.3205/oc000059Test https://doi.org/10.2310/8000.2013.131059Test https://doi.org/10.1097/00041327-200412000-00015Test https://doi.org/10.1111/jon.12371Test https://doi.org/10.1159/000440712Test https://doi.org/10.2169/internalmedicine.55.6603Test https://doi.org/10.1016/j.jstrokecerebrovasdis.2015.01.006Test https://doi.org/10.1186/s12883-014-0231-yTest http://nbn-resolving.de/urn:nbn:de:0183-oc0000592Test http://www.egms.de/en/journals/oc/2017-7/oc000059.shtmlTest |
| حقوق: | http://creativecommons.org/licenses/by/4.0Test/ |
| رقم الانضمام: | edsbas.6B4233C6 |
| قاعدة البيانات: | BASE |
| DOI: | 10.3205/oc000059 |
|---|