Clinical Reasoning: An 82-Year-Old Woman With Subacute Ophthalmoparesis and Ataxia

We present the case of an 82-year-old woman with subacute altered mental status, oculomotor disturbances, and ataxia. On examination, she exhibited bilateral ptosis, complete horizontal ophthalmoplegia, and limited vertical eye movements during upgaze associated with prominent truncal ataxia. Cerebr...

Full description

Saved in:
Bibliographic Details
Published inNeurology Vol. 101; no. 5; p. e570
Main Authors Rodrigo-Gisbert, Marc, Llaurado, Arnau, Baucells, Andres, Auger, Cristina, González, Victoria
Format Journal Article
LanguageEnglish
Published United States 01.08.2023
Subjects
Aged, 80 and over
Ataxia
Cerebellar Ataxia
Clinical Reasoning
Contrast Media
Female
Gadolinium
Humans
Ophthalmoplegia - diagnosis
Ophthalmoplegia - etiology
Online AccessGet more information

Cover

More Information
Summary:We present the case of an 82-year-old woman with subacute altered mental status, oculomotor disturbances, and ataxia. On examination, she exhibited bilateral ptosis, complete horizontal ophthalmoplegia, and limited vertical eye movements during upgaze associated with prominent truncal ataxia. Cerebral MRI showed a mild hyperintensity on T2 and fluid-attenuated inversion recovery sequences in the posterior brainstem extending to the upper cervical cord, without gadolinium enhancement. Clinical and radiologic features suggested an encephalomyelitis with prominent brainstem involvement. We summarize the comprehensive differential diagnosis in patients with subacute brainstem encephalitis, which includes infectious paraneoplastic syndromes and inflammatory disorders. This case highlights the relevance of performing a wide methodical screening for malignancy in case of negative initial workup.
ISSN:1526-632X
DOI:10.1212/WNL.0000000000207246