Abstract

A case report of LR palsy
20 yr old female presented with c/o double vision for 2 days. Previous history of ear pain, tinnitus and vertigo 1 week prior to onset of double vision. Proceeded to check for other cranial nerve involvement having gradenigo syndrome in mind but found Unilateral LMN facial nerve palsy (symptoms not mentioned by patient), rotatory nystagmus and gaze induced nystagmus. Ear pathology was ruled out with ENT consult and neuro consult for gaze induced nystagmus was taken. MRI revealed a pontomedullary lesion suggestive of demyelination / autoimmune pathology. CSF analysis and blood work up was done to look for evidence of TB/ demyelination / autoimmune diseases. All turned out to be negative except for Ab to PCNA which was borderline positive. Patient was treated with I V steroids and improvement in LR movement noted. She was discharged with tapering advice of oral steroids. Possible diagnosis of Rhomb encephalitis was considered causing 6,7 and 8 th nerve palsy.