Bilateral, vertical supranuclear gaze palsy following unilateral midbrain infarct
A 60-year-old man recently admitted for bipedal oedema, endocarditis and a persistently positive COVID-19 swab with a history of anticoagulation on rivaroxaban for atrial fibrillation, transitional cell carcinoma, cerebral amyloid angiopathy, diabetes and hypertension presented with sudden onset dip...
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| Veröffentlicht in: | BMJ case reports 2020-11, Vol.13 (11), p.e238422 |
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| description | A 60-year-old man recently admitted for bipedal oedema, endocarditis and a persistently positive COVID-19 swab with a history of anticoagulation on rivaroxaban for atrial fibrillation, transitional cell carcinoma, cerebral amyloid angiopathy, diabetes and hypertension presented with sudden onset diplopia and vertical gaze palsy. Vestibulo-ocular reflex was preserved. Simultaneously, he developed a scotoma and sudden visual loss, and was found to have a right branch retinal artery occlusion. MRI head demonstrated a unilateral midbrain infarct. This case demonstrates a rare unilateral cause of bilateral supranuclear palsy which spares the posterior commisure. The case also raises a question about the contribution of COVID-19 to the procoagulant status of the patient which already includes atrial fibrillation and endocarditis, and presents a complex treatment dilemma regarding anticoagulation. |
| doi_str_mv | 10.1136/bcr-2020-238422 |
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Vestibulo-ocular reflex was preserved. Simultaneously, he developed a scotoma and sudden visual loss, and was found to have a right branch retinal artery occlusion. MRI head demonstrated a unilateral midbrain infarct. This case demonstrates a rare unilateral cause of bilateral supranuclear palsy which spares the posterior commisure. The case also raises a question about the contribution of COVID-19 to the procoagulant status of the patient which already includes atrial fibrillation and endocarditis, and presents a complex treatment dilemma regarding anticoagulation.</description><identifier>ISSN: 1757-790X</identifier><identifier>EISSN: 1757-790X</identifier><identifier>DOI: 10.1136/bcr-2020-238422</identifier><identifier>PMID: 33148560</identifier><language>eng</language><publisher>England: BMJ Publishing Group Ltd</publisher><subject><![CDATA[Aspirin - administration & dosage ; Asymptomatic ; Atrial Fibrillation - complications ; Atrial Fibrillation - drug therapy ; Betacoronavirus - isolation & purification ; Blindness - diagnosis ; Blindness - etiology ; Brain cancer ; Brain Stem Infarctions - diagnostic imaging ; Brain Stem Infarctions - drug therapy ; Brain Stem Infarctions - physiopathology ; Cardiac arrhythmia ; Case reports ; contraindications and precautions ; Coronavirus Infections - complications ; Coronavirus Infections - diagnosis ; Coronavirus Infections - physiopathology ; Coronaviruses ; COVID-19 ; Diplopia ; Diplopia - diagnosis ; Diplopia - etiology ; Endocarditis ; Endocarditis, Bacterial - complications ; Endocarditis, Bacterial - diagnosis ; Endocarditis, Bacterial - physiopathology ; Eye movements ; Factor Xa Inhibitors - administration & dosage ; Humans ; Magnetic Resonance Imaging - methods ; Male ; Middle Aged ; neuroopthalmology ; Ophthalmoplegia - diagnosis ; Ophthalmoplegia - etiology ; Pandemics ; Platelet Aggregation Inhibitors - administration & dosage ; Pneumonia, Viral - complications ; Pneumonia, Viral - diagnosis ; Pneumonia, Viral - physiopathology ; Pyrazoles - administration & dosage ; Pyridones - administration & dosage ; Retinal Artery Occlusion - diagnostic imaging ; Retinal Artery Occlusion - drug therapy ; Retinal Artery Occlusion - etiology ; Retinal Artery Occlusion - physiopathology ; SARS-CoV-2 ; Stroke ; TB and other respiratory infections ; Tomography, Optical Coherence - methods ; Treatment Outcome ; Ultrasonic imaging ; Unusual Association of Diseases/Symptoms ; Veins & arteries ; visual pathway]]></subject><ispartof>BMJ case reports, 2020-11, Vol.13 (11), p.e238422</ispartof><rights>BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ.</rights><rights>This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained. https://bmj.com/coronavirus/usage</rights><rights>BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ. 2020</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b492t-d5f0ef80d2b45295b3a06fa1a19dd567931b28a736d19a05f93be4c51559d20d3</citedby><cites>FETCH-LOGICAL-b492t-d5f0ef80d2b45295b3a06fa1a19dd567931b28a736d19a05f93be4c51559d20d3</cites><orcidid>0000-0002-7130-9801</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7643481/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7643481/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,881,27901,27902,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33148560$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Yang, Yunfei</creatorcontrib><creatorcontrib>Qidwai, Umair</creatorcontrib><creatorcontrib>Burton, Benjamin J L</creatorcontrib><creatorcontrib>Canepa, Carlo</creatorcontrib><title>Bilateral, vertical supranuclear gaze palsy following unilateral midbrain infarct</title><title>BMJ case reports</title><addtitle>BMJ Case Rep</addtitle><addtitle>BMJ Case Rep</addtitle><description>A 60-year-old man recently admitted for bipedal oedema, endocarditis and a persistently positive COVID-19 swab with a history of anticoagulation on rivaroxaban for atrial fibrillation, transitional cell carcinoma, cerebral amyloid angiopathy, diabetes and hypertension presented with sudden onset diplopia and vertical gaze palsy. Vestibulo-ocular reflex was preserved. Simultaneously, he developed a scotoma and sudden visual loss, and was found to have a right branch retinal artery occlusion. MRI head demonstrated a unilateral midbrain infarct. This case demonstrates a rare unilateral cause of bilateral supranuclear palsy which spares the posterior commisure. The case also raises a question about the contribution of COVID-19 to the procoagulant status of the patient which already includes atrial fibrillation and endocarditis, and presents a complex treatment dilemma regarding anticoagulation.</description><subject>Aspirin - administration & dosage</subject><subject>Asymptomatic</subject><subject>Atrial Fibrillation - complications</subject><subject>Atrial Fibrillation - drug therapy</subject><subject>Betacoronavirus - isolation & purification</subject><subject>Blindness - diagnosis</subject><subject>Blindness - etiology</subject><subject>Brain cancer</subject><subject>Brain Stem Infarctions - diagnostic imaging</subject><subject>Brain Stem Infarctions - drug therapy</subject><subject>Brain Stem Infarctions - physiopathology</subject><subject>Cardiac arrhythmia</subject><subject>Case reports</subject><subject>contraindications and precautions</subject><subject>Coronavirus Infections - complications</subject><subject>Coronavirus Infections - diagnosis</subject><subject>Coronavirus Infections - physiopathology</subject><subject>Coronaviruses</subject><subject>COVID-19</subject><subject>Diplopia</subject><subject>Diplopia - diagnosis</subject><subject>Diplopia - etiology</subject><subject>Endocarditis</subject><subject>Endocarditis, Bacterial - complications</subject><subject>Endocarditis, Bacterial - diagnosis</subject><subject>Endocarditis, Bacterial - physiopathology</subject><subject>Eye movements</subject><subject>Factor Xa Inhibitors - administration & dosage</subject><subject>Humans</subject><subject>Magnetic Resonance Imaging - methods</subject><subject>Male</subject><subject>Middle Aged</subject><subject>neuroopthalmology</subject><subject>Ophthalmoplegia - diagnosis</subject><subject>Ophthalmoplegia - etiology</subject><subject>Pandemics</subject><subject>Platelet Aggregation Inhibitors - administration & dosage</subject><subject>Pneumonia, Viral - complications</subject><subject>Pneumonia, Viral - diagnosis</subject><subject>Pneumonia, Viral - physiopathology</subject><subject>Pyrazoles - administration & dosage</subject><subject>Pyridones - administration & dosage</subject><subject>Retinal Artery Occlusion - diagnostic imaging</subject><subject>Retinal Artery Occlusion - drug therapy</subject><subject>Retinal Artery Occlusion - etiology</subject><subject>Retinal Artery Occlusion - physiopathology</subject><subject>SARS-CoV-2</subject><subject>Stroke</subject><subject>TB and other respiratory infections</subject><subject>Tomography, Optical Coherence - methods</subject><subject>Treatment Outcome</subject><subject>Ultrasonic imaging</subject><subject>Unusual Association of Diseases/Symptoms</subject><subject>Veins & arteries</subject><subject>visual pathway</subject><issn>1757-790X</issn><issn>1757-790X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNqNkd1LHTEQxYO0qFiffZOFvpTarfnezYvQSr9AkEILfQuTTfY2l2z2Ntm16F_f3F69aqHgvMzA_OZwhoPQEcFvCWHy1HSpppjimrKWU7qD9kkjmrpR-MezB_MeOsx5iUsxwlvOdtEeW09C4n309b0PMLkE4U115dLkOwhVnlcJ4twFB6lawI2rVhDyddWPIYy_fVxUc7w7qwZvTQIfKx97SN30Aj3vC-0Ob_sB-v7xw7fzz_XF5acv5-8uasMVnWoreuz6FltquKBKGAZY9kCAKGuFbBQjhrbQMGmJAix6xYzjnSBCKEuxZQfobKO7ms3gbOfiVOzoVfIDpGs9gtePN9H_1IvxSjeSM96SIvDqViCNv2aXJz343LkQILpxzppy0SjZYk4L-vIfdDnOKZb3_lJcqlbJQp1uqC6NOSfXb80QrNeJ6ZKYXiemN4mVi-OHP2z5u3wK8HoDmGH5BLWTe3hr8H_0Hw47rPY</recordid><startdate>20201104</startdate><enddate>20201104</enddate><creator>Yang, Yunfei</creator><creator>Qidwai, Umair</creator><creator>Burton, Benjamin J L</creator><creator>Canepa, Carlo</creator><general>BMJ Publishing Group Ltd</general><general>BMJ Publishing Group LTD</general><general>BMJ Publishing Group</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-7130-9801</orcidid></search><sort><creationdate>20201104</creationdate><title>Bilateral, vertical supranuclear gaze palsy following unilateral midbrain infarct</title><author>Yang, Yunfei ; Qidwai, Umair ; Burton, Benjamin J L ; Canepa, Carlo</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b492t-d5f0ef80d2b45295b3a06fa1a19dd567931b28a736d19a05f93be4c51559d20d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Aspirin - administration & dosage</topic><topic>Asymptomatic</topic><topic>Atrial Fibrillation - complications</topic><topic>Atrial Fibrillation - drug therapy</topic><topic>Betacoronavirus - isolation & purification</topic><topic>Blindness - diagnosis</topic><topic>Blindness - etiology</topic><topic>Brain cancer</topic><topic>Brain Stem Infarctions - diagnostic imaging</topic><topic>Brain Stem Infarctions - drug therapy</topic><topic>Brain Stem Infarctions - physiopathology</topic><topic>Cardiac arrhythmia</topic><topic>Case reports</topic><topic>contraindications and precautions</topic><topic>Coronavirus Infections - complications</topic><topic>Coronavirus Infections - diagnosis</topic><topic>Coronavirus Infections - physiopathology</topic><topic>Coronaviruses</topic><topic>COVID-19</topic><topic>Diplopia</topic><topic>Diplopia - diagnosis</topic><topic>Diplopia - etiology</topic><topic>Endocarditis</topic><topic>Endocarditis, Bacterial - complications</topic><topic>Endocarditis, Bacterial - diagnosis</topic><topic>Endocarditis, Bacterial - physiopathology</topic><topic>Eye movements</topic><topic>Factor Xa Inhibitors - administration & dosage</topic><topic>Humans</topic><topic>Magnetic Resonance Imaging - methods</topic><topic>Male</topic><topic>Middle Aged</topic><topic>neuroopthalmology</topic><topic>Ophthalmoplegia - diagnosis</topic><topic>Ophthalmoplegia - etiology</topic><topic>Pandemics</topic><topic>Platelet Aggregation Inhibitors - administration & dosage</topic><topic>Pneumonia, Viral - complications</topic><topic>Pneumonia, Viral - diagnosis</topic><topic>Pneumonia, Viral - physiopathology</topic><topic>Pyrazoles - administration & dosage</topic><topic>Pyridones - administration & dosage</topic><topic>Retinal Artery Occlusion - diagnostic imaging</topic><topic>Retinal Artery Occlusion - drug therapy</topic><topic>Retinal Artery Occlusion - etiology</topic><topic>Retinal Artery Occlusion - physiopathology</topic><topic>SARS-CoV-2</topic><topic>Stroke</topic><topic>TB and other respiratory infections</topic><topic>Tomography, Optical Coherence - methods</topic><topic>Treatment Outcome</topic><topic>Ultrasonic imaging</topic><topic>Unusual Association of Diseases/Symptoms</topic><topic>Veins & arteries</topic><topic>visual pathway</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Yang, Yunfei</creatorcontrib><creatorcontrib>Qidwai, Umair</creatorcontrib><creatorcontrib>Burton, Benjamin J L</creatorcontrib><creatorcontrib>Canepa, Carlo</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>BMJ case reports</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Yang, Yunfei</au><au>Qidwai, Umair</au><au>Burton, Benjamin J L</au><au>Canepa, Carlo</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Bilateral, vertical supranuclear gaze palsy following unilateral midbrain infarct</atitle><jtitle>BMJ case reports</jtitle><stitle>BMJ Case Rep</stitle><addtitle>BMJ Case Rep</addtitle><date>2020-11-04</date><risdate>2020</risdate><volume>13</volume><issue>11</issue><spage>e238422</spage><pages>e238422-</pages><issn>1757-790X</issn><eissn>1757-790X</eissn><abstract>A 60-year-old man recently admitted for bipedal oedema, endocarditis and a persistently positive COVID-19 swab with a history of anticoagulation on rivaroxaban for atrial fibrillation, transitional cell carcinoma, cerebral amyloid angiopathy, diabetes and hypertension presented with sudden onset diplopia and vertical gaze palsy. Vestibulo-ocular reflex was preserved. Simultaneously, he developed a scotoma and sudden visual loss, and was found to have a right branch retinal artery occlusion. MRI head demonstrated a unilateral midbrain infarct. This case demonstrates a rare unilateral cause of bilateral supranuclear palsy which spares the posterior commisure. The case also raises a question about the contribution of COVID-19 to the procoagulant status of the patient which already includes atrial fibrillation and endocarditis, and presents a complex treatment dilemma regarding anticoagulation.</abstract><cop>England</cop><pub>BMJ Publishing Group Ltd</pub><pmid>33148560</pmid><doi>10.1136/bcr-2020-238422</doi><orcidid>https://orcid.org/0000-0002-7130-9801</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Aspirin - administration & dosage Asymptomatic Atrial Fibrillation - complications Atrial Fibrillation - drug therapy Betacoronavirus - isolation & purification Blindness - diagnosis Blindness - etiology Brain cancer Brain Stem Infarctions - diagnostic imaging Brain Stem Infarctions - drug therapy Brain Stem Infarctions - physiopathology Cardiac arrhythmia Case reports contraindications and precautions Coronavirus Infections - complications Coronavirus Infections - diagnosis Coronavirus Infections - physiopathology Coronaviruses COVID-19 Diplopia Diplopia - diagnosis Diplopia - etiology Endocarditis Endocarditis, Bacterial - complications Endocarditis, Bacterial - diagnosis Endocarditis, Bacterial - physiopathology Eye movements Factor Xa Inhibitors - administration & dosage Humans Magnetic Resonance Imaging - methods Male Middle Aged neuroopthalmology Ophthalmoplegia - diagnosis Ophthalmoplegia - etiology Pandemics Platelet Aggregation Inhibitors - administration & dosage Pneumonia, Viral - complications Pneumonia, Viral - diagnosis Pneumonia, Viral - physiopathology Pyrazoles - administration & dosage Pyridones - administration & dosage Retinal Artery Occlusion - diagnostic imaging Retinal Artery Occlusion - drug therapy Retinal Artery Occlusion - etiology Retinal Artery Occlusion - physiopathology SARS-CoV-2 Stroke TB and other respiratory infections Tomography, Optical Coherence - methods Treatment Outcome Ultrasonic imaging Unusual Association of Diseases/Symptoms Veins & arteries visual pathway |
| title | Bilateral, vertical supranuclear gaze palsy following unilateral midbrain infarct |
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