Ganesh Kasinathan^1,, Rudra Dewi Thavarajan¹

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.

Babinski-Nageotte, hemiparethesia, nystagmus, cavernoma, pneumonia