中英CLIPPERS综合征金婷
A73-year-oldright-handedmanwithahistoryofhypertensionandhyperlipidemiapresentedwithan18-monthhistoryofdiplopiaandunsteadygait.Healsonotedoscillatingvisionwhenturninghisheadtotheleft.Thediplopiawashorizontalandwasworselookingatobjectsonhisrightoratadistance.Overayear,hisbalanceworsenedtothepointwhereherequiredawalkerduetorecurrentfalls.Sixmonthspriortopresentation,hedevelopeddysphagia(liquidsmorethanthesolids).Hewasalsonotedtohaveshort-termmemoryproblemsinthelast3months.Onexamination,hehadmoderatecognitiveimpairmentwithaMontrealCognitiveAssessment(MoCA)scoreof20/30withpredominantdeficitsinvisuospatialfunctionsandlanguage.Glabellar,bilateralpalmomental,andsnoutreflexeswerepresent.Theleftpupilwassurgicalandnonreactivetolight,andtherewasmechanicalptosisontheleft.Hehadleftexotropiawithfulleyemovements,bilateralhorizontalgaze-evokednystagmus,andupbeatnystagmusonupgaze.Motorstrengthandtonewerenormal.Hewasdiffuselyhyperreflexicwithbilateralextensorplantarresponses.Detailedsensoryexaminationwasnormal.Dysmetriawaspresentbilaterally,moreprominentontheleft上海白癜风专科医院看白癜风选老牌医院
