Brainstem and Spinal Arachnoiditis Ossificans Associated With Neurocysticercosis: A Case Report.

Arachnoiditis ossificans (AO), a very rare entity that can cause severe neurological deficit, is associated with an inflammatory response and compressive effect on the spinal cord. A 65-year-old woman with diagnosis of arachnoiditis ossificans, who had a past medical history of neurocysticercosis diagnosed eight years before the actual onset that was accompanied by obstructive hydrocephalus and required bilateral ventriculoperitoneal shunts, presented with lower limb paresis. The spinal CT reported large calcified subdural spinal plaques. She was treated with high-dose steroids with subsequent improvement of the clinical manifestations. Spinal neurocysticercosis is a rare manifestation of this disease, although the Mexican population is especially prone to it, due to the endemic presence of this entity, it can provoke spinal arachnoiditis. We conclude that the chronic inflammation of the spinal meninges induced by the cysticercosis could encourage the arachnoid cells to go through osteoblastic metaplasia with consequent production of thick calcium deposits, such as those found in AO. Thus it may be associated with AO. We present, to our knowledge, the first patient with AO-associated neurocysticercosis.

Wall-Eyed Monocular Internuclear Ophthalmoplegia (WEMINO) and Millard-Gubler Syndromes in a Patient with Isolated Pontine Infarction: Topographic, Oculomotor, and Radiological Analysis of Two Very Uncommon Conditions.

The syndromes of wall-eyed monocular internuclear ophthalmoplegia and Millard-Gubler are very rare clinical complexes commonly caused by pontine infarction, hemorrhage, or tumors that compromise the paramedian tegmentum, medial longitudinal fascicle, and the basis pontis. We present the case of a 58-year-old female with an isolated pontine infarction characterized by acute vertigo, sudden horizontal diplopia due to ipsilateral internuclear ophthalmoplegia with exotropia, facial palsy and contralateral hemiparesis. This report analyzes, theorizes, and emphasizes the correlation between these atypical neurological findings, the pontine anatomy, and magnetic resonance imaging; encouraging the clinician to make expeditious diagnoses using the bedside skills and a high-quality oculomotor clinical examination. The phenotype and simultaneity of both syndromes makes this case a didactic exercise for the topo-diagnosis based on the neurology of eye movements, the intrinsic physiology of the pons, and the pathways that emerge or project towards it.