CASE 1

This 42 year old female presented with a three month history of headache, gait unsteadiness, cognitive decline and diplopia. Her prior health was unremarkable apart from the fact that she was diagnosed as having a left sided Bell's Palsy seven years previously. On esamination she presented with impairment of cognition, gait unsteadiness, a left sided LMN facial paresis, deafness in the left ear, horizontal gaze nystagmus with the fast component to the left, and incoordination of the left limbs.

You are invited to suggest a diagnosis and recommend a therapeutic strategy. This case is also featured on the CANS Bulletin Board.

(case submitted by Dr Randolph Cheeks)

CASE 2

This 43 year old right handed normotensive non-diabetic female patient was well until six months ago when she developed left frontal headache which was non-throbbing in character and gradually increased in severity. She experienced no vomiting or epileptic seizures and did not complain of diplopia or epistaxis. Physical examination revealed intact cognition, intact cranial nerves, minimal left sided axial proptosis and normal long tracts.

The images are of her MRI scan.

What is the diagnosis ? and What is the suggested management ?

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(CHECK FOR THE ANSWER NEXT MONTH)

ANSWER : NEUROMA OF THE INTRACAVERNOUS PORTION OF THE OPHTHALMIC NERVE ! Surgery - Transsylvian Approach.

- case submitted by Dr. Randolph Cheeks -

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