A Limited Form of Neuromyelitis Optica With a Lesion of the Fourth Nerve Nucleus

Ogasawara, Mikihide; Sakai, Tsutomu; Kono, Yu; Shikishima, Keigo; Tsuneoka, Hiroshi

doi:10.1097/wno.0b013e31829e0b24

Cited by 5 publications

(3 citation statements)

References 7 publications

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“…Patients with NMOSD may manifest various ocular motor deficits in addition to classic characteristics of optic neuritis and transverse myelitis. The ocular motility abnormalities observed in NMOSD includes dorsal midbrain syndrome, 4,5 trochlear nerve palsy, 6,7 wall-eyed bilateral internuclear ophthalmoplegia syndrome, 8 ocular oscillations, 9 and restriction in extraocular movements such as that seen in our patient.…”

Section: T a G G E D H 1 Case Reportt A G G E D E N Dsupporting

confidence: 52%

Nystagmus and diplopia in a patient with positive aquaporin-4 antibody

Koh

Teo

Halim

et al. 2019

Canadian Journal of Ophthalmology

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Section: T a G G E D H 1 Case Reportt A G G E D E N Dsupporting

confidence: 52%

Nystagmus and diplopia in a patient with positive aquaporin-4 antibody

Koh

Teo

Halim

et al. 2019

Canadian Journal of Ophthalmology

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“…3 Therefore, patients with NMO or NMO spectrum disorders (NMOSDs) may present various ocular motor deficits caused by the disruption of anatomical circuits, in addition to optic neuritis, weakness, numbness and hiccups. There are several reports of abnormal ocular findings in NMO or NMOSDs, such as wall-eyed bilateral internuclear ophthalmoplegia syndrome, 4 ocular oscillations 5 and trochlear nerve palsy 6 (see Table 1). However, dorsal midbrain syndrome was mentioned only by Gilmore et al in correspondence, without detailed documentation.…”

Section: Discussionmentioning

confidence: 99%

Anti-aquaporin-4 antibody-positive dorsal midbrain syndrome

et al. 2014

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Neuromyelitis optica spectrum disorders (NMOSD) can cause various ocular motor disorders in addition to optic neuritis. Ocular motor findings associated with NMOSD include spontaneous vertical and gaze-evoked nystagmus, wall-eyed bilateral internuclear ophthalmoplegia, and trochlear nerve palsy. The association between dorsal midbrain syndrome and anti-aquaporin-4 antibody seropositivity has not been reported. Here, we report a patient displaying typical dorsal midbrain syndrome and anti-aquaporin-4 antibody seropositivity.

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“…A number of oculomotor manifestations, similar to the ones described in MS, have been observed with both AQP4- and MOG-antibody associated NMOSD including (1) walled-eyes bilateral internuclear ophthalmoplegia (WEBINO) associated with a midbrain tegmentum lesion adjacent to the aqueduct on brain MRI [ 138 , 139 ], (2) ocular oscillations, including up-beating, down-beating, central vestibular nystagmus, and opsoclonus myoclonus syndrome, [ 140 ], (3) nuclear [ 141 ] and bilateral trochlear nerve palsy [ 142 ], and (4) central Horner syndrome [ 143 ], which has occasionally been described in MS in relation to brainstem lesions [ 144 , 145 , 146 ]. Thus, with overlay in brainstem symptomatology between MS and NMOSD, MRI of the brain and spinal cord, serology, and most importantly, high index of suspicion are expected to lead to the final diagnosis.…”

Section: Brainstem and Cerebellar Pattern Recognition: From Clinicmentioning

confidence: 93%

Pattern Recognition of the Multiple Sclerosis Syndrome

2017

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During recent decades, the autoimmune disease neuromyelitis optica spectrum disorder (NMOSD), once broadly classified under the umbrella of multiple sclerosis (MS), has been extended to include autoimmune inflammatory conditions of the central nervous system (CNS), which are now diagnosable with serum serological tests. These antibody-mediated inflammatory diseases of the CNS share a clinical presentation to MS. A number of practical learning points emerge in this review, which is geared toward the pattern recognition of optic neuritis, transverse myelitis, brainstem/cerebellar and hemispheric tumefactive demyelinating lesion (TDL)-associated MS, aquaporin-4-antibody and myelin oligodendrocyte glycoprotein (MOG)-antibody NMOSD, overlap syndrome, and some yet-to-be-defined/classified demyelinating disease, all unspecifically labeled under MS syndrome. The goal of this review is to increase clinicians’ awareness of the clinical nuances of the autoimmune conditions for MS and NMSOD, and to highlight highly suggestive patterns of clinical, paraclinical or imaging presentations in order to improve differentiation. With overlay in clinical manifestations between MS and NMOSD, magnetic resonance imaging (MRI) of the brain, orbits and spinal cord, serology, and most importantly, high index of suspicion based on pattern recognition, will help lead to the final diagnosis.

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A Limited Form of Neuromyelitis Optica With a Lesion of the Fourth Nerve Nucleus

Cited by 5 publications

References 7 publications

Nystagmus and diplopia in a patient with positive aquaporin-4 antibody

Nystagmus and diplopia in a patient with positive aquaporin-4 antibody

Anti-aquaporin-4 antibody-positive dorsal midbrain syndrome

Pattern Recognition of the Multiple Sclerosis Syndrome

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