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Short Case Presentation. Dr. Sania Khalid. Background. Young female developed quadriplegia over a year Bed-ridden for 2 months Loss of bowel and bladder control We will be showing you few clinical tests performed on this lady. Name the sign and interpret.

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short case presentation

Short Case Presentation

Dr. Sania Khalid

  • Young female developed quadriplegia over a year
  • Bed-ridden for 2 months
  • Loss of bowel and bladder control
  • We will be showing you few clinical tests performed on this lady.
mri cervical and thoracic spine1
MRI cervical and thoracic spine.
  • MRI of cervical spine and thoracic spine showed a bilobed mass like lesion in the left intervertebral foramina at C4-C5 level with an intraspinal component showing severe compressionover the spinal cord at this level. Post Gandolinium sacn showed intense heterogenous enhancement.
  • Impression: was of a dumb-bell shaped neurofibroma at left intervertebral foramina of C4-C5 causing severe external compression over the spinal cord.
  • On histopathology :

Spindle shaped neoplasm, cells having wavy nuclei with tapering ends.Hyper and hypocellular areas were scene. In few areas verrucay bodies present. No mitosis or atypia noted. Most like a benign peripheral nerve sheath tumor or schwanomma.

case 2
Case 2

Myriad of deficits: Diagnosing Topsy-turvey Cases

Dr. Muhammad Zaman Khan

Resident Department of Medicine

Jinnah Hospital Lahore

closely observe this examination and answer following questions
Closely observe this examination and answer following questions
  • Write down three most important findings.
  • What three steps are important in relevant examination?
  • Write down a list of differential diagnosis?
  • How would you investigate this patient?

Complete loss of vision in left eye

  • Fundoscopic examination is unremarkable
  • Rest of neurological examination is unremarkable except for absent left corneal reflex and loss of left forehead sensations.
nerves involved
Nerves involved
  • Left
    • II
    • III
    • IV
    • V1
    • VI



causes of multiple cranial nerve palsies
Causes of multiple cranial nerve palsies
  • Cavernous sinus Pathologies
  • Orbital apex syndrome
  • Tumors
  • Inflammation (viral, fungal, bacterial, granulomatous, vasculitis)
  • Diabetes
  • Ophthalmoplegic migraine
  • Complete blood count
  •  Electrolytes
  •  Glucose and hemoglobin A1C
  •  Renal and liver function tests
  •  Angiotensin converting enzyme
  •  Antinuclear antibody
  •  Anti-dsDNA antibody
  •  Anti-Sm antibody
  •  Antinuclear cytoplasmic antibody
  •  Fluorescent treponemal antibody test
  •  Lyme serologies
  •  Serum protein electrophoresis
  •  Erythrocyte sedimentation rate (ESR)
  •  C reactive protein

CSF analysis

  • MRI Brain with Gadolinium
diagnostic criteria for tolosa hunt syndrome
Diagnostic criteria for Tolosa Hunt Syndrome
  • One or more episodes of unilateral orbital pain lasting for weeks (untreated)
  •  Third, fourth, and/or sixth cranial nerve palsy and/or granuloma detected by magnetic resonance imaging (MRI) or biopsy
  •  Cranial nerve palsy begins within two weeks of onset of orbital pain
  •  Symptoms resolve within 72 hours when treated with sufficient corticosteroids
  •  Other etiologies are excluded by appropriate investigation

  Tessitore E, Tessitore A. Tolosa-Hunt syndrome preceded by facial palsy.Headache 2000; 40:393.

  • Adams AH, Warner AM. Painful ophthalmoplegia: report of a case with cerebral involvement and psychiatric complications. Bull Los Angeles Neurol Soc 1975; 40:49.

 • Prednisone 80 to 100 mg daily for three days.

• If the pain has resolved, taper to 60 mg daily, then 40 mg, then 20 mg, then 10 mg every two weeks.