Dhanoop Mohandas
Brain stem syndrome may be a condition commonly characterized by limb weakness, ophthalmoplegia, and gait disturbances. The common causes of brain stem syndrome are ischemia, neoplasia, demyelination, infective and hamartomatous lesions within the brain. Imaging ideally with an MRI scan is sometimes diagnostic in most cases and possibly following other investigations to spot systemic abnormality or CSF changes before appropriate therapy will be introduced. A 42yr old Caucasian lady presented with nonspecific symptoms like lethargy, malaise, was off food for a pair of months and had lost a substantial amount of weight (4 stones = 25.4kgs). She was admitted to the hospital with nausea and vomiting for some weeks and complained of a lump in her throat. Gastroscopy was unremarkable. She also complained of sudden onset of visual impairment for the previous few days and examination showed vertical Nystagmus. She also complained of bizarre sensation in her feet and soreness within the bottom of her feet when she stood up.
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