ABSTRACT
Wernicke encephalopathy (WE) is a neurological emergency that develops in the setting of thiamine deficiency, and is characterised by symptoms of confusion, ophthalmoplegia and gait ataxia. Less recognised signs and symptoms include vestibular dysfunction, hearing impairment, peripheral neuropathy, and in severe cases, coma. This case study describes a non-alcoholic patient, who presents with significant auditory and vestibular changes in addition to the classic symptoms of WE. This case report describes a non-alcoholic patient who developed deafness, severe horizontal canal paresis and symptoms of palinacousis in the setting of WE as a complication of a recent gastric sleeve operation.
Subject(s)
Gastric Bypass/adverse effects , Hearing Loss/etiology , Obesity, Morbid/surgery , Wernicke Encephalopathy/complications , Wernicke Encephalopathy/diagnostic imaging , Adult , Diagnosis, Differential , Female , Hearing Loss/diagnosis , Humans , Magnetic Resonance Imaging , Obesity, Morbid/complications , Postoperative Complications , Wernicke Encephalopathy/etiologyABSTRACT
A case of metformin encephalopathy is presented in a patient on haemodialysis for end-stage diabetic renal failure. The patient presented with frequent falls and clinical signs of Parkinsonism, on a background of recent anorexia and significant weight loss. Magnetic resonance imaging showed bilateral, symmetrical abnormalities centred on the lentiform nuclei. Metformin was withheld and signs and symptoms quickly resolved. We hypothesise that metformin may cause thiamine deficiency in patients with end-stage renal failure resulting in a specific metabolic encephalopathy.
Subject(s)
Brain Diseases/chemically induced , Brain Diseases/drug therapy , Hypoglycemic Agents/adverse effects , Metformin/adverse effects , Thiamine/therapeutic use , Vitamin B Complex/therapeutic use , Adult , Brain Diseases/diagnostic imaging , Diabetic Nephropathies/diagnostic imaging , Diabetic Nephropathies/therapy , Female , HumansABSTRACT
Acute oculomotor nerve palsy requires urgent exclusion of aneurysmal compression. We report a 62year old man with a transient right third nerve palsy with pupillary involvement, who was found to have neurovascular compression of the cisternal oculomotor nerve as it curved over a duplicated superior cerebellar artery on high resolution MR imaging. Direct vascular compression should be considered in patients with isolated cranial neuropathies in whom other pathologies have been excluded.
Subject(s)
Nerve Compression Syndromes/diagnostic imaging , Oculomotor Nerve Diseases/diagnostic imaging , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Nerve Compression Syndromes/complications , Oculomotor Nerve Diseases/complicationsABSTRACT
We describe a rare case of vascularised orbital roof and calvarial erosions with an associated venous malformation. In the absence of infection, malignancy, trauma and eosinophillic granuloma, the closest previously described entity is vanishing bone disease. Computed tomography (CT), MRI, catheter angiography and pathology were all important in the diagnostic workup to enable surgical planning for biopsy and reconstruction. Ongoing CT and MRI follow-up imaging will determine future treatment planning.
