Letters to Editor
4.
Zivadinov R, Ramanathan M, Dolic K, Marr K, Karmon Y, Siddiqui AH, et al. Chronic cerebrospinal venous insufficiency in multiple sclerosis: Diagnostic, pathogenetic, clinical and treatment perspectives. Expert Rev Neurother 2011;11:1277‑94. 5. Brooks DJ, Leenders KL, Head G, Marshall J, Legg NJ, Jones T. Studies on regional cerebral oxygen utilisation and cognitive function in multiple sclerosis. J Neurol Neurosurg Psychiatry 1984;47:1182‑91. 6. Putnam TJ. Evidence of vascular occlusion in multiple sclerosis and encephalomyelitis. Arch Neurol Neuropsychol 1935;32:1298‑321. 7. Wakefield AJ, More LJ, Difford J, McLaughlin JE. Immunohistochemical study of vascular injury in acute multiple sclerosis. J Clin Pathol 1994;47:129‑33. 8. Khiat A, Lesage J, Boulanger Y. Quantitative MRS study of Baló’s concentric sclerosis lesions. Magn Reson Imaging 2007;25:1112‑5. 9. Mowry EM, Woo JH, Ances BM. Baló’s concentric sclerosis presenting as a stroke‑like syndrome. Nat Clin Pract Neurol 2007;3:349‑54. Access this article online Quick Response Code:
Website: www.neurologyindia.com PMID: *** DOI: 10.4103/0028-3886.136978
Received: 30‑03‑2014 Review completed: 11‑04‑2014 Accepted: 27‑05‑2014
The one‑and‑a‑half syndrome as the presenting sign of systemic lupus erythematosus Sir, One‑and‑a‑half syndrome (OHS) is characterized by an internuclear ophthalmoplegia (INO) and lateral gaze palsy due to the involvement of the pontine gaze center and ipsilateral medial longitudinal fasciculus (MLF). Most frequent causes include multiple sclerosis and brainstem ischemic stroke. We report a patient of systemic lupus erythematosus (SLE) presenting with one‑and‑a‑half syndrome.
In September 2013, a 34‑year‑old man with a history of bicytopenia, seizures, and periodic delusions was brought with complaints of diplopia and dizziness. Previous testing for anti nuclear antibody (ANA) and other SLE serum markers was negative. The patient also had a history of tingling sensation, pain, and weakness in his legs, non‑erosive arthritis of hands and feet, skin plaques on extensor sides of both elbows, and a history of bloating that responded to gluten‑free regimen despite a negative duodenal biopsy for celiac disease. Neurologic examination revealed a one‑and‑a‑half syndrome with freezing of the left eye and restricted adduction of the right eye in conjugate horizontal gaze [Figure 1]. Incomplete ptosis of the left eyelid was also evident. Diplopia was reported by patient in right horizontal gaze. No other cranial nerve palsies was found. Bilateral foot drop was also noted. Laboratory evaluation at this admission revealed a positive ANA (+), borderline Anti‑ds‑DNA (value: 96 IU/ml; normal:
4.
Zivadinov R, Ramanathan M, Dolic K, Marr K, Karmon Y, Siddiqui AH, et al. Chronic cerebrospinal venous insufficiency in multiple sclerosis: Diagnostic, pathogenetic, clinical and treatment perspectives. Expert Rev Neurother 2011;11:1277‑94. 5. Brooks DJ, Leenders KL, Head G, Marshall J, Legg NJ, Jones T. Studies on regional cerebral oxygen utilisation and cognitive function in multiple sclerosis. J Neurol Neurosurg Psychiatry 1984;47:1182‑91. 6. Putnam TJ. Evidence of vascular occlusion in multiple sclerosis and encephalomyelitis. Arch Neurol Neuropsychol 1935;32:1298‑321. 7. Wakefield AJ, More LJ, Difford J, McLaughlin JE. Immunohistochemical study of vascular injury in acute multiple sclerosis. J Clin Pathol 1994;47:129‑33. 8. Khiat A, Lesage J, Boulanger Y. Quantitative MRS study of Baló’s concentric sclerosis lesions. Magn Reson Imaging 2007;25:1112‑5. 9. Mowry EM, Woo JH, Ances BM. Baló’s concentric sclerosis presenting as a stroke‑like syndrome. Nat Clin Pract Neurol 2007;3:349‑54. Access this article online Quick Response Code:
Website: www.neurologyindia.com PMID: *** DOI: 10.4103/0028-3886.136978
Received: 30‑03‑2014 Review completed: 11‑04‑2014 Accepted: 27‑05‑2014
The one‑and‑a‑half syndrome as the presenting sign of systemic lupus erythematosus Sir, One‑and‑a‑half syndrome (OHS) is characterized by an internuclear ophthalmoplegia (INO) and lateral gaze palsy due to the involvement of the pontine gaze center and ipsilateral medial longitudinal fasciculus (MLF). Most frequent causes include multiple sclerosis and brainstem ischemic stroke. We report a patient of systemic lupus erythematosus (SLE) presenting with one‑and‑a‑half syndrome.
In September 2013, a 34‑year‑old man with a history of bicytopenia, seizures, and periodic delusions was brought with complaints of diplopia and dizziness. Previous testing for anti nuclear antibody (ANA) and other SLE serum markers was negative. The patient also had a history of tingling sensation, pain, and weakness in his legs, non‑erosive arthritis of hands and feet, skin plaques on extensor sides of both elbows, and a history of bloating that responded to gluten‑free regimen despite a negative duodenal biopsy for celiac disease. Neurologic examination revealed a one‑and‑a‑half syndrome with freezing of the left eye and restricted adduction of the right eye in conjugate horizontal gaze [Figure 1]. Incomplete ptosis of the left eyelid was also evident. Diplopia was reported by patient in right horizontal gaze. No other cranial nerve palsies was found. Bilateral foot drop was also noted. Laboratory evaluation at this admission revealed a positive ANA (+), borderline Anti‑ds‑DNA (value: 96 IU/ml; normal:
