Transient supranuclear paresis of the abduction in viral encephalitis of the brainstem.
The supranuclear paresis of the abducens system, also known as posterior internuclear ophthalmoplegia of abduction, is a very rare disorder clinically characterized by unilateral or bilateral abduction paresis sometimes associated with nystagmus of the contralateral adducting eye, slowing of abduction saccades, and intact horizontal vestibulo-ocular reflex. Here, we report a 35-year-old woman who presented transient left side abduction deficit in conjunction, as the only symptom of self-limited viral encephalitis of the brainstem. Brain MRI including DWI and ADC maps showed an area of abnormal signal intensity in the mid-right ponto-mesencephalic junction. PCR analysis of cerebrospinal fluid showed an enterovirus infection. Spontaneous clinical recovery rapidly occurred 2 days after onset. The brainstem lesion was undetectable at 5-week brain MRI follow-up.
Rufa
Alessandra
A
Dipartimento di Scienze Neurologiche e del Comportamento, Università di Siena, Viale Bracci 2, 53100, Siena, Italy. rufa@unisi.it
Cerase
Alfonso
A
Annunziata
Pasquale
P
De Santi
Lorenzo
L
Buccoliero
Rosaria
R
Monti
Lucia
L
Federico
Antonio
A
D000328:Adult; D001933:Brain Stem / Q000473:pathology / Q000821:virology*; D018792:Encephalitis, Viral / Q000150:complications* / Q000473:pathology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D013494:Supranuclear Palsy, Progressive / Q000209:etiology*