Early Dorsal Midbrain Syndrome Mimicking an Adie's Tonic Pupil

BACKGROUND: While tonic pupils have been attributed to various diseases, including syphilis, herpes zoster, orbital trauma, temporal arteritis, endometriosis, and paraneoplastic syndromes, obstructive hydrocephalus has not been implicated. CASE REPORT: A 36-year-old woman visited a neurology department with a 7-day history of throbbing headache and blurred vision in both eyes. She had early dorsal midbrain syndrome mimicking an Adie's tonic pupil, and cholinergic supersensitivity was demonstrated using topical 0.125% pilocarpine. Brain MRI revealed obstructive hydrocephalus at the level of the aqueduct of Sylvius, and her symptoms resolved 4 days after surgery. CONCLUSIONS: We report a patient with early dorsal midbrain syndrome that was initially believed to represent a tonic pupil on the basis of pharmacologic testing. The findings in our patient suggested that early dorsal midbrain syndrome mimicking an Adie's tonic pupil can be caused by obstructive hydrocephalus compressing the Edinger-Westphal nucleus.

Common Carotid Artery Agenesis: Duplex Ultrasonographic Findings

BACKGROUND: Agenesis of the common carotid artery (CCA) resulting in separation of the origin of the external carotid artery (ECA) and internal carotid artery (ICA) from the aortic arch is rare. Fewer than 25 cases have been reported, and correlative ultrasound data were available for only 1 of them. CASE REPORT: A 52-year-old woman visited the hospital with a 3-day history of vertigo and headache. Color-coded duplex ultrasonography performed to evaluate the carotid and vertebral arteries revealed a normal configuration on the left side. However, the right CCA could not be found; instead, there were two vessels of approximately equal size in close proximity to each other. The cerebral angiographic findings were consistent with the ultrasonographic findings. The ECA and ICA originated directly from the brachiocephalic trunk, and the ECA arose proximal to the ICA. CONCLUSIONS: The ultrasonographic findings revealed absence of the CCA, the ECA and ICA originating separately from the aortic arch. Color-coded duplex ultrasonography appears to be an effective and sensitive method for detecting absence of the CCA. These findings should help to further our understanding of the embryologic development of the carotid arteries.

A Case of Cutaneous Horn Arising from Dermatofibroma

Cutaneous horn is a clinical diagnosis based upon the presence of a large protuberant mass of keratin. We report a case of cutaneous horn arising from dermatofibroma in a 31-year old woman. A silver whitish colored comical hyperkeratotic protruding lesion (1.0  0.7 cm size) from the red brown colored nodule was observed. Histopathologic findings showed characteristic findings of dermatofibroma and cutaneous horn. The lesion was removed by surgical excision.