Neurocysticercosis is a common tropical infection presenting with neurological signs. It commonly presents as seizures but various other focal neurological presentations have been reported. Though neurocysticercosis have been reported to present as isolated internuclear ophthalmoplegia, we report the first case of neurocysticercosis presenting as wall-eyed monoocular internuclear ophthalmoplegia syndrome with contraversive ocular tilt reaction.
This article aims at highlighting the importance of suspecting thyrotoxicosis in cases of recurrent periodic flaccid paralysis; especially in Asian men to facilitate early diagnosis of the former condition. A case report of a 28 year old male patient with recurrent periodic flaccid paralysis has been presented. Hypokalemia secondary to thyrotoxicosis was diagnosed as the cause of the paralysis. The patient was given oral potassium intervention over 24 hours. The patient showed complete recovery after the medical intervention and was discharged after 24 hours with no residual paralysis. Thyrotoxic periodic paralysis (TPP) is a complication of thyrotoxicosis, more common amongst males in Asia. It presents as acute flaccid paralysis in a case of hyperthyroidism with associated hypokalemia. The features of thyrotoxicosis may be subtle or absent. Thus, in cases of recurrent or acute flaccid muscle paralysis, it is important to consider thyrotoxicosis as one of the possible causes, and take measures accordingly.
images in clinical medicineT h e n e w e ng l a n d j o u r na l o f m e dic i n e n engl j med 369;15 nejm.org october 10, 2013 e19 A 43-year-old man with history of rheumatic heart disease presented with a 2-month history of palpitations and breathlessness. On examination, the pulse was regular at 110 beats per minute, and the blood pressure was 180/40 mm Hg. He had a bounding carotid pulse (Corrigan's sign), a collapsing brachial pulse, pistol-shot sounds heard over the femoral arteries (Traube's sign), and a hyperdynamic apex that was shifted laterally and inferiorly. Inspection of the oral cavity showed systolic pulsations of the uvula (Müller's sign; see video). On auscultation, there was a grade 3 early diastolic murmur at the left sternal border and a pansystolic murmur at apex. Electrocardiography showed sinus tachycardia with left axis deviation and left ventricular hypertrophy. Transthoracic echocardiography revealed severe aortic regurgitation with moderate mitral regurgitation. In chronic severe aortic regurgitation, a large stroke volume and systolic hypertension produce a variety of physical signs, as in this patient. Müller's sign is a rare manifestation of a large stroke volume. Like most eponymic signs, it has not been adequately evaluated for precision or accuracy and does not predict the clinical outcome of aortic regurgitation.
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