American Journal of Medical Sciences and Medicine
ISSN (Print): 2327-6681 ISSN (Online): 2327-6657 Website: http://www.sciepub.com/journal/ajmsm Editor-in-chief: Apply for this position
Open Access
Journal Browser
Go
American Journal of Medical Sciences and Medicine. 2015, 3(3), 33-35
DOI: 10.12691/ajmsm-3-3-2
Open AccessCase Report

Babinski-Nageotte Syndrome Secondary to Hemorrhagic Medullary Cavernoma in a District Hospital: A Variant of Wallernberg Syndrome

Ganesh Kasinathan1, and Rudra Dewi Thavarajan1

1Department of Internal Medicine, Segamat Hospital, KM 6 Jalan Genuang, Segamat, Johor, Malaysia

Pub. Date: August 14, 2015

Cite this paper:
Ganesh Kasinathan and Rudra Dewi Thavarajan. Babinski-Nageotte Syndrome Secondary to Hemorrhagic Medullary Cavernoma in a District Hospital: A Variant of Wallernberg Syndrome. American Journal of Medical Sciences and Medicine. 2015; 3(3):33-35. doi: 10.12691/ajmsm-3-3-2

Abstract

Babinski-Nageotte syndrome is a rare clinical entity in a young healthy individual. This syndrome includes a group of neurological symptoms resulting from injury to both medial and lateral medulla of the brain. It is a variant of Wallernberg syndrome. This case report describes a 27 year old healthy Malay gentleman who presented with a three day history of right facial numbness and weakness associated with left sided body hemiparesis and hemiparethesia. He had obvious right hypoglossal nerve palsy. He also complained of vertigo, dysphagia, dysarthria and vomiting. He denied having any hiccups. Physical examination revealed an obvious right Horner’s syndrome with upper motor neuron right facial nerve palsy. There was no facial tenderness. Motor power of the left upper and lower limbs were graded as 2/5. His gag reflex on the right side was absent with abundant oral secretions. Jerky nystagmus of the right eye at all gazes was seen along with diplopia. A plain computed tomography scan of the brain showed a hyperdense lesion suggestive of hemorrhagic medullary cavernoma. He subsequently developed respiratory distress due to pneumonia in which he required mechanical ventilation. However, he succumbed to his illness due to Extended Spectrum Beta Lactamase (ESBL) Klebsiella pneumonia on day 6 of admission. This crossed finding is diagnostic of Babinski-Nageotte syndrome. The unavailability of Magnetic Resonance Imaging/Angiography facility may provide a diagnostic challenge to elucidate the exact etiology for this syndromein a district hospital.

Keywords:
Babinski-Nageotte hemiparethesia nystagmus cavernoma pneumonia

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References:

[1]  J. J. F. F. Babinski, J. Nageotte: Hémiasynergie, latéropulsion et miosis bulbaire. Nouvelle iconographie de la Salpêtrière 1902: 492.
 
[2]  Krasnianski M et. al. Babinski Nageotte syndrome and Hemimedullary syndrome (Reinhold’s) are clinically and morphologically dinstint conditions. J Neurol. 2003 Aug; 250(8): 938-42.
 
[3]  Masayoshi Tada, MD; Mari Tada, MD et. al. Babinski-Nageotte syndrome with ipsilateral hemiparesis. Arch Neurol. 2005; 62(4):676-677.
 
[4]  Nakane H, Okada Y, Sadoshima S, Fujishima M. Babinski-Nageotte syndrome on magnetic resonance imaging. Stroke. 1991; 22:272-275.
 
[5]  Hao Li, Yan Ju, Bo-wen Cai et. al. Experience of microsurgical treatment of brainstem cavernomas: Report of 37 cases. Neurology India. May-Jun 2009 Vol 57 Issue 3 273.
 
[6]  Kupersmith MJ, Kalish H, Epstein F, et. al. Natural history of brainstem cavernous malformations. Neurosurgery 2001; 48:47-53; discussion 53-4.
 
[7]  Yasui T, Komiyama M et. al. A brainstem cavernoma demonstrating a dramatic, spontaneous decrease in size during follow up: case report and review of the literature. Surg Neurol. 2005 Feb; 63(2):170-3.
 
[8]  Porter RW, Detwiler PW, Spetzler RF et. al. Cavernous malformations of the brainstem: experience with 100 patients. J Neurosurg. 1999 Jan; 90(1):50-8.
 
[9]  Steinberg GK, Chang SD, Gewirtz RJ et. al. Microsurgical resection of brainstem, thalamic, and basal ganglia angiographically occult vascular malformations. Neurosurgery. 2000; 46:260-70; discussion 270-61.
 
[10]  Cenzato M, Stefini R, Ambrosi C et. al. Post-operative remnants of brainstem cavernomas: incidence, risk factors and management. Acta Neurochir. (Wien) 2008; 150:879-86; discussion 887.