Multiple Osteosclerotic Lesions: ARare Presentation of Hyperparathyroidism Secondary to Hypovitaminosis D.

Hypovitaminosis D is an under-recongnised and important factor responsible for secondary hyperparathyroidism. Hyperparathyroidism mostly presents with osteolytic lesions, especially in secondary hyperparathyroidism with renal failure. There are some rare presentations of hyperparathyroidism as focal or generalized osteosclerotic lesions. The exact mechanism for the osteosclerosis is still unknown, but there are some theories suggesting an exaggerated response of osteoblasts in response to prolonged osteolytic activity in order to restore bone loss. Here, we report a case of secondary hyperparathyroidism secondary to severe Vitamin D deficiency presented as multiple osteosclerotic lesions.

Classic Raymond Syndrome.

Classic Raymond syndrome presents with abducens nerve palsy on the ipsilateral side with contralateral hemiparesis and facial nerve paralysis. A 60-year gentleman presented with deviation of left angle of mouth and right sided weakness. Examination showed that he had left sided abducens nerve palsy, with contralateral central facial paralysis and paresis. MRI of brain confirmed left pontine infarct. These findings were consistent with classic Raymond syndrome. Till now, only a few cases have been reported worldwide, this being the first case reported in South Asia. This case confirms that classic Raymond syndrome is different from the common type of Raymond syndrome in terms of sparing of coritcofacial fibers in the latter type.