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Bilateral, vertical supranuclear gaze palsy following unilateral midbrain infarct
A 60-year-old man recently admitted for bipedal oedema, endocarditis and a persistently positive COVID-19 swab with a history of anticoagulation on rivaroxaban for atrial fibrillation, transitional cell carcinoma, cerebral amyloid angiopathy, diabetes and hypertension presented with sudden onset dip...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7643481/ https://www.ncbi.nlm.nih.gov/pubmed/33148560 http://dx.doi.org/10.1136/bcr-2020-238422 |
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author | Yang, Yunfei Qidwai, Umair Burton, Benjamin J L Canepa, Carlo |
author_facet | Yang, Yunfei Qidwai, Umair Burton, Benjamin J L Canepa, Carlo |
author_sort | Yang, Yunfei |
collection | PubMed |
description | A 60-year-old man recently admitted for bipedal oedema, endocarditis and a persistently positive COVID-19 swab with a history of anticoagulation on rivaroxaban for atrial fibrillation, transitional cell carcinoma, cerebral amyloid angiopathy, diabetes and hypertension presented with sudden onset diplopia and vertical gaze palsy. Vestibulo-ocular reflex was preserved. Simultaneously, he developed a scotoma and sudden visual loss, and was found to have a right branch retinal artery occlusion. MRI head demonstrated a unilateral midbrain infarct. This case demonstrates a rare unilateral cause of bilateral supranuclear palsy which spares the posterior commisure. The case also raises a question about the contribution of COVID-19 to the procoagulant status of the patient which already includes atrial fibrillation and endocarditis, and presents a complex treatment dilemma regarding anticoagulation. |
format | Online Article Text |
id | pubmed-7643481 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-76434812020-11-12 Bilateral, vertical supranuclear gaze palsy following unilateral midbrain infarct Yang, Yunfei Qidwai, Umair Burton, Benjamin J L Canepa, Carlo BMJ Case Rep Unusual Association of Diseases/Symptoms A 60-year-old man recently admitted for bipedal oedema, endocarditis and a persistently positive COVID-19 swab with a history of anticoagulation on rivaroxaban for atrial fibrillation, transitional cell carcinoma, cerebral amyloid angiopathy, diabetes and hypertension presented with sudden onset diplopia and vertical gaze palsy. Vestibulo-ocular reflex was preserved. Simultaneously, he developed a scotoma and sudden visual loss, and was found to have a right branch retinal artery occlusion. MRI head demonstrated a unilateral midbrain infarct. This case demonstrates a rare unilateral cause of bilateral supranuclear palsy which spares the posterior commisure. The case also raises a question about the contribution of COVID-19 to the procoagulant status of the patient which already includes atrial fibrillation and endocarditis, and presents a complex treatment dilemma regarding anticoagulation. BMJ Publishing Group 2020-11-04 /pmc/articles/PMC7643481/ /pubmed/33148560 http://dx.doi.org/10.1136/bcr-2020-238422 Text en © BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ. This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.https://bmj.com/coronavirus/usage |
spellingShingle | Unusual Association of Diseases/Symptoms Yang, Yunfei Qidwai, Umair Burton, Benjamin J L Canepa, Carlo Bilateral, vertical supranuclear gaze palsy following unilateral midbrain infarct |
title | Bilateral, vertical supranuclear gaze palsy following unilateral midbrain infarct |
title_full | Bilateral, vertical supranuclear gaze palsy following unilateral midbrain infarct |
title_fullStr | Bilateral, vertical supranuclear gaze palsy following unilateral midbrain infarct |
title_full_unstemmed | Bilateral, vertical supranuclear gaze palsy following unilateral midbrain infarct |
title_short | Bilateral, vertical supranuclear gaze palsy following unilateral midbrain infarct |
title_sort | bilateral, vertical supranuclear gaze palsy following unilateral midbrain infarct |
topic | Unusual Association of Diseases/Symptoms |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7643481/ https://www.ncbi.nlm.nih.gov/pubmed/33148560 http://dx.doi.org/10.1136/bcr-2020-238422 |
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