SUMMARYA 27-year-old woman with a history of recurrent nausea and vomiting in the setting of idiopathic intracranial hypertension (IIH) was admitted for control of unremitting nausea and vomiting. Initial antiemetic therapy included optimisation of IIH therapy by titrating acetazolamide, in addition to using ondansetron and metoclopramide as needed, with minimal relief. She was ultimately treated with palonosetron with complete resolution of her acute nausea. Nausea, often treated with 5-hydroxytryptamine (5-HT3) receptor antagonists, approved for perioperative and chemotherapy-induced nausea, are used off-label to treat nausea and vomiting outside of those settings. The efficacy of different regimens has been compared in the literature and continues to remain controversial. When choosing from different 5-HT3 antagonists there are other considerations, in addition to efficacy to consider: dosing schedule, half-life, time of onset, duration and cost-tobenefit ratio, and although one 5-HT3 antagonist may not have been effective, another one may be. In our case palonosetron, with a significantly longer half-life than other 5-HT3 antagonists, was effective in resolving nausea when compared with the more commonly used ondansetron. BACKGROUND
This 77-year-old male with probable progressive supranuclear palsy (PSP) diagnosed in 2011 was admitted from a nursing home following a fall. Examination demonstrated parkinsonism, axial rigidity, limited downgaze with 10 degrees of vertical excursion, and slow, hypometric saccades. Repeat imaging was obtained to exclude acute injury. Prior magnetic resonance imaging (MRI) had not shown any evidence of corticospinal tract (CST) degeneration, and the patient exhibited no signs of alternative pathology on clinical examination. Neuroimaging in PSP may show atrophy of the midbrain tegmentum with sparing of the pons, the hummingbird sign, which is reported to be highly sensitive in PSP. 1 Corticospinal tract degeneration has been described with motor neuron diseases, such as amyotrophic lateral sclerosis, 2 but is rarely reported with tauopathies. 3 Although prior reports have linked CST degeneration and tauopathies, 4 with 1 case describing MRI evidence of CST atrophy in a corticobasal degeneration patient, 5 this is the first, to our knowledge, of PSP presenting with the evidence of CST degeneration. This supports growing evidence that tauopathies affect both pyramidal and extrapyramidal pathways. 2-6 Declaration of Conflicting Interests The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
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