Atlanta GA USA 2015 Case 1 Case 1 Male 78 years old Benign hyperplasia prostatic treated with surgery thirty years ago Three years ago Abnormal gait Progressive falls Decrease on tone of his voice ID: 721619
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Slide1
Video Competition
MDS-PAS School For Young NeurologistAtlanta, GA, USA. 2015
Case 1Slide2
Case 1
Male 78 years old. Benign hyperplasia prostatic treated with surgery thirty years ago.
Three years ago.
Abnormal gait
Progressive falls
Decrease on tone of his voiceDysarthric languageCephalic lateralized tremor
HistorySlide3
VideoSlide4
Audience discussion
PhenomenologyDifferential diagnosis
InvestigationsSlide5
Diagnosis
Bobble - Head doll Syndrome and
parinaud
syndrome
secundary to Pineal cystSlide6
Bobble - Doll Head Syndrome
Rare and an interesting movement disorder described by Benton et al (1966).
Continuous or episodic forward and backward head nodding at times associated with side to side movements of the head (2-3 Hz )
It is usually associated with expansile lesions in the third ventricular region.
Patient:
Dysarthria, supranuclear gaze palsy with slow horizontal saccadic movements and without
convergence
gaze
Reddy O. J Pediatr Neurosci. 2014Slide7
Patophysiology
Due to the pressure effect of dilated third ventricle, which distorts the dorsomedial red nucleus and dentatorubrothalamic pathways.
In addition, there is compression of medial thalamus, the latter having their somatotropic motor representation of head and neck area.
Guerreiro H. Acta Neurochir. 2012
Reddy O. J Pediatr Neurosci. 2014