Pontine hemorrhage causing oculopalatal tremor and multiple cranial neuropathies

Update item information
Identifier OPT_and_M_CN
Title Pontine hemorrhage causing oculopalatal tremor and multiple cranial neuropathies
Subject Sixth Nerve Palsy; Pons; Pendular Nystagmus; Oculopalatal Tremor
Creator Daniel R. Gold, DO, Departments of Neurology, Ophthalmology, Neurosurgery, Otolaryngology - Head & Neck Surgery, Emergency Medicine, and Medicine, The Johns Hopkins School of Medicine
Description This is a 45-yo-woman who had a dorsal pontine cavernoma that bled 2 years prior to this video. Symptoms included diplopia and oscillopsia. On examination, she had left>right facial palsies (upper and lower face from involvement of the nucleus/fascicle - i.e., lower motor neuron palsies) and sixth nerve palsies (large angle esotropia is apparent in the video). There was no INO and no horizontal gaze palsy on this examination. Regarding the facial palsies, she had developed synkinesis, or aberrant regeneration involving areas around the left lip and right side of the nose - e.g., with blinking, areas of the lower face contracted, which is the result of nerves getting misrouted to the wrong muscles after injury. Additionally, given the close proximity of the central tegmental tract in the dorsal pons, she developed oculopalatal tremor as a result of a disruption in Mollaret's triangle. Nystagmus was pendular vertical-torsional, and palatal tremor was also present. Gabapentin was not tolerated, and memantine did not improve her oscillopsia.
Publisher Spencer S. Eccles Health Sciences Library, University of Utah
Date 2017
Type Image/MovingImage
Format video/mp4
Rights Management Copyright 2017. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright
Holding Institution Spencer S. Eccles Health Sciences Library, University of Utah, 10 N 1900 E, SLC, UT 84112-5890
Collection Neuro-ophthalmology Virtual Education Library: NOVEL http://NOVEL.utah.edu
Language eng
ARK ark:/87278/s6kh49kt
Setname ehsl_novel_gold
Date Created 2017-02-23
Date Modified 2018-01-22
ID 1209725
Reference URL https://collections.lib.utah.edu/ark:/87278/s6kh49kt