Toxoplasmosis presenting with multiple cranial nerve palsies and cavernous sinusitis: A case report

@#Toxoplasmosis is a worldwide zoonosis caused by an intracellular protozoan parasite, Toxoplasma gondii. We report here a diabetic patient who was diagnosed as toxoplasmosis with multiple cranial nerve palsies and cavernous sinusitis. A 37-year-old male presented with an 11-day history of gingival pain, one day history of ptosis and diplopia. He has been having diabetes mellitus for 6 years, and has a history of contact with cats. After admission, his symptoms worsened with right 3rd to 7th cranial nerve palsies. The brain magnetic resonance imaging (MRI) showed cavernous sinusitis in the right sellar region. Serology for toxoplasma was positive for IgM and negative IgG. The patient was treated with oral clindamycin (900 mg/day) and dexamethasone (15 mg/day). The right visual acuity and lid-conjunctival swelling improved after 3 days. At follow-up after a month, the movement of the right eye significantly improved. This case demonstrate the rare occurrence of multiple cranial nerve (3rd to 7th) palsies from toxoplasmosis cavernous sinusitis, which is a potentially treatable condition.

A Case of Lateral Sinus Thrombosis Presenting with Cranial Nerve Syndrome

Cerebral venous thrombosis (CVT) is a disease sometimes associated with a wide variety of clinical signs and symp-toms. Single or multiple cranial nerve palsies without evidence of any other signs and symptoms have not, so far, been considered as a relevant syndrome of CVT. A 49-year-old woman was admitted to our hospital because of diplopia, vertigo with tinnitus and ataxia which had begun approximately three weeks before. Neurological examination revealed a right 6th nerve palsy by a red glass test and an impaired tandem walking test. Laboratory tests including CSF exami-nation and brain MRI were normal but MR venography and following 4-vessel angiography showed thrombosis in the left transverse and sigmoid sinuses and suspicious thrombosis in the right lateral sinus. She was treated with heparin and proceeded to get well.

Clinical Analysis of Brain Stem Glioma

The authors reviewed the cases of 25 patients, who were diagnosed as brain stem glioma by computerized tomography. The common presenting complains were the cranial nerve palsies, long tract signs and cerebellar dysfunction. Four distinct types of brain stem gliomas were identified based on CT scan characteristics: Type I included diffuse tumors; Type II included focal tumors; Type III included tumors involving cervicomedullary portion; Type IV(a) included exophytic tumors extending ventrally or laterally into the cerebellopontine or prepontine cistersns; Type IV(b) included exophytic tumors extending dorsally into fourth ventricle. The clinical presentation, efficacy of surgical intervention, pathology, and prognosis of those tumors were correlated within these typing. The prognosis was poorer in children who presented with multiple cranial nerve palsies, and such children were more likely to have malignant astrocytoma. Type I(diffuse tumors) had the poorest prognosis and less response to radiation while Type II(focal tumors) had relatively good response to radiation. Through surgery and post operative radiotherapy, survival times were significantly longer in patients with Type III(cervicomedullary tumor) which was more likely to be low grade astrocytoma. The prognosis of patients with Type IV-b(4th ventricle tumor) was variable but better than those with Type IV-a(prepontine tumors) or Type I(diffuse tumors). Patient with tumor biopsies that were histologically benign survived significantly longer than those whose tumors were malignant. It is concluded that patient with Type III cervicomedullary tumors or Type IV exophytic tumor may be improved through surgery and postoperative radiotherapy, and radiotherapy is useful method in treatment of patients with Type I diffuse tumors or Type II focal tumors.