Acute disseminated encephalomyelitis is an immune mediated demyelinating disorder of the central nervous system, it predominantly affects children in the age group between of 5-8 years. Is most widely thought to be a post-viral, post-vaccination autoimmune phenomenon. We present a case of 40 years old Pakistani male arrived to ER agitated with decrease level of consciousness and delirium, develop tonic-clonic convulsion and it was relieved by DIAZEPAM. This is the first attack to the patient with no past medical history of similar presentation. MRI showed supra and infratentorial white matter high T2/FLAIR signal abnormalities, involving supratentorial cortical and subcortical parito-occipital region, also to less extent at deep white matter predominantly right tempro-occipital region in asymmetric pattern. Involvement of juxta cortical and U fibers. MRI raised the possibility of adult onset Acute disseminated encephalomyelitis, after exclusion of other causes of juxta cortical and U fibers involvement (based on imaging analysis with consideration of clinical presentation and available lab results).
The oculomotor nerve palsy is a rare neurological deficit, it is associated with numerous underlying pathologies. Including stroke, neoplasms, trauma, post-surgical inflammation, and microvascular damage from chronic disease. It can cause a set of neurological deficits, including diplopia from oculomotor nerve involvement, decreased visual acuity from optic neuropathy, facial hypoesthesia from involvement of the trigeminal nerve, and less frequently facial pain. We present a case of 52 years old female patient who presented with a history of lateral divination of the left eye associated with ipsilateral drooping of upper eyelid, visual disturbance, and pupil dysfunction. MRI and MRA were performed and in conventional sequences plus 3D FIESTA sequence and it shows a signal void structure, compressing the left oculomotor nerve after passing through left chiasmatic cistern and upon entrance to cavernous sinus. Reformatted images demonstrate that this structure arising from distal left internal carotid artery at lateral part of cavernous sinus represents a saccular aneurysm in the cavernous part of the internal carotid. Aneurysms can cause direct compression of the third cranial nerve either by the enlargement of an unruptured aneurysm or by rupture of the aneurysmal sac resulting in third cranial nerve palsy.
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