A Rare Neuro-Ophthalmological Condition in a Patient with Lung Adenocarcinoma: The Eight-and-a-Half Syndrome, Case Report and Review of the Literature

Cruciani, Alessandro; Motolese, Francesco; Todisco, Antonio; Lazzaro, Vincenzo Di; Assenza, Giovanni

doi:10.3390/brainsci12040451

Cited by 2 publications

(2 citation statements)

References 47 publications

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“…Depending on the anatomical site affected, pathology in the brainstem can give rise to unique brainstem syndromes with specific localising signs, such as Foville, Weber or Wallenberg syndromes, and many more. These brainstem syndromes are most frequently caused by ischaemic stroke, but they have also been reported as secondary to infection and tumours 10 11. In our case, the patient’s symptoms do not point towards any specific brainstem syndromes, possibly due to pontomedullary involvement and a large area of cerebral oedema.…”

Section: Discussionmentioning

confidence: 43%

Tumour-like presentation of brainstem tuberculoma: a lesson learnt

et al. 2022

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Brainstem tuberculoma is diagnostically challenging as it lacks clinical clues and imaging mimics a high-grade glioma (HGG). We report the case of an adolescent girl diagnosed with brainstem HGG, who was referred to our centre for Gamma Knife. Initial MRI showed a pontomedullary junction, ring-enhancing lobulated lesion demonstrating distinct central hypointensity on T2-weighted (T2W) and fluid-attenuated inversion recovery (FLAIR) images with extensive vasogenic oedema. An alternative diagnosis of infection was entertained, and biopsy was suggested; however, the parents opted for a trial of alternative treatment. Suboccipital craniotomy and debulking were only performed 3 months later when her symptoms worsened, and MRI revealed enlargement of the lesion. A cheesy ‘tumour’ was noted intraoperatively; histopathological findings later confirmed chronic granulomatous inflammation. In an endemic area, a high index of suspicion of a tuberculoma is vital specifically in the presence of central T2W/FLAIR hypointensity of a ring-enhancing lesion.

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Section: Discussionmentioning

confidence: 43%

Tumour-like presentation of brainstem tuberculoma: a lesson learnt

et al. 2022

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“…Neuroimaging, such as MRI, may help identify a specific lesion site, such as lacunar infarction of the MLF ( Figure 3 ). Neuroimaging may also reveal intracranial tumors with mass effect (e.g., pseudo-INO via oculomotor palsy), or brainstem tumors or metastases disrupting ocular motor nuclei or the MLF directly ( 13 ).…”

Section: Discussionmentioning

confidence: 99%

Medial longitudinal fasciculus (MLF)-syndrome in a multimorbid patient with alcohol use disorder: a case report

Arvin,

Kristensen,

Glud

2024

AME Case Rep

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Background Patients with multiple comorbidities can present as a diagnostic challenge as overlapping symptomatology complicates the discovery of emergent pathology. Symptoms of alcohol misuse or orthostatic hypotension may especially cloud the diagnosis of insidious neurological disease, such as posterior circulation infarct. With a growing elderly population, it is expected that the complex multimorbid patient will represent a growing challenge to prompt stroke detection and treatment. Case Description Herein, we present a 69-year-old male with a history of alcohol abuse, chronic obstructive pulmonary disease, type 2 diabetes mellitus, paroxysmal atrial fibrillation, and congestive heart disease. The patient arrived at our emergency department with dizziness, ataxia, and diplopia. His symptoms had a sudden onset and gradual exacerbation over a span of 2 days, notably aggravated by standing and walking, but relieved when seated or supine. Notably, a month before admission, the patient had been treated with anti-congestive medications for severe congestive heart failure leading to a weight loss of 55 lbs over period of 2 weeks. The initial differential diagnoses were orthostatism, Wernicke’s encephalopathy (WE), and ischemic stroke. Magnetic resonance imaging (MRI) revealed a subacute infarct in the medial longitudinal fasciculus (MLF). Conclusions The case underscores the challenge in diagnosing neurological conditions in multimorbid individuals. The combination of various underlying conditions may drastically complicate the diagnosis. Successful diagnosis and treatment necessitates meticulous evaluation of clinical observations, medical history, current medications, and pertinent diagnostic evaluations to effectively narrow down the potential differential diagnoses.

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A Rare Neuro-Ophthalmological Condition in a Patient with Lung Adenocarcinoma: The Eight-and-a-Half Syndrome, Case Report and Review of the Literature

Cited by 2 publications

References 47 publications

Tumour-like presentation of brainstem tuberculoma: a lesson learnt

Tumour-like presentation of brainstem tuberculoma: a lesson learnt

Medial longitudinal fasciculus (MLF)-syndrome in a multimorbid patient with alcohol use disorder: a case report

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