Pseudotumor Cerebri Syndrome Without Headache in an Obese Male With Eight Restricted Cerebrospinal Fluid (CSF) Oligoclonal Bands: A Case Report.

Pseudotumor cerebri syndrome (PTCS) is a condition caused by an abnormal elevation of intracranial pressure (ICH), which may be primary (idiopathic intracranial hypertension) or because of an identifiable secondary cause. We present a rare case of an obese male who complained of gradual bilateral vision loss for one year without headaches and tinnitus. On fundoscopy, he had high-grade bilateral papilledema and, on lumbar puncture, he had an elevated intracranial pressure of 260 mmH2O. Cerebrospinal fluid (CSF) was unique for eight restricted oligoclonal bands while extensive other demyelinating workup was negative. He was started on acetazolamide initially and subsequently proceeded with bilateral optic nerve sheath fenestration (ONSF) with mild improvement in the right eye and no improvement in the left eye. Although the causative mechanism of PTCS is a matter of debate, immune-mediated processes are one of the proposed mechanisms that may play a role in the pathophysiology of PTCS, evidenced by the presence of oligoclonal bands (OCBs) and pro-inflammatory markers in CSF. PTCS diagnosed in men and patients with OCBs poses an increased risk of vision loss as this case and literature documented. Therefore, prompt treatment through therapeutic lumbar punctures, acetazolamide therapy concurrently with weight loss, and surgical intervention in severe or refractory cases are necessary.

On doing two things at once: temporal constraints on actions in language comprehension.

In two experiments, we investigated how text comprehension is influenced by the interaction between the properties of actions and the temporal relations specified by adverbs. Participants read short narratives describing a protagonist who performed two actions that involved similar sensorimotor systems (e.g., chopping wood and painting a fence) or different ones (e.g., whistling a melody and painting a fence). The actions were described as simultaneous or successive by means of the temporal adverbs while and after, respectively. Comprehension, both in Spanish and in English, was markedly impaired (longer reading times and lower subjective coherence) for sentences including the adverb while and actions involving the same sensorimotor system. However, when one of the same sensorimotor system actions was described as a mental plan (e.g., chopping wood and thinking of painting a fence), comprehension was equally easy with the adverbs while and after. These results are compatible with a revised version of the indexical hypothesis that specifies how comprehension is guided by syntax and embodied constraints within multiple noninteracting mental spaces.