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[Traumatic bilateral MLF syndrome--a case report]
T Kuroiwa1, H Tanabe, H Takatsuka
1Department of Neurosurgery, Osaka Mishima Critical Care Medical Center, Japan.
Abstract:
A case of traumatic bilateral medial longitudinal fasciculus (MLF) syndrome is reported. An 18-year-old man who had been struck on the occipital region in a traffic accident was admitted to our center. On admission, the consciousness evaluated by the Japan Coma Scale was 30. Skull X-ray film revealed a linear skull fracture of the left occipital bone. CT scan showed subdural hematoma in the right frontotemporal region, contusion of bilateral frontal lobes and the left cerebellar hemisphere, subarachnoid hemorrhage, and pneumoce phalus. Two weeks after the injury, his consciousness improved and he was diagnosed as having bilateral MLF syndrome. Barbiturate, dehydration and steroid therapy were added to for intracranial hemorrhage. One month later, MLF syndrome improved and he was discharged without any neurological deficit.
Insights
Traumatic brain injury can cause bilateral medial longitudinal fasciculus (MLF) syndrome. This case report details a patient who recovered fully from this rare neurological condition following a severe head injury.
Area of Science:
- Neuroscience
- Neurology
- Trauma Surgery
Background:
- The medial longitudinal fasciculus (MLF) is a crucial bilateral white matter tract connecting cranial nerve nuclei involved in conjugate eye movement.
- Bilateral MLF syndrome is a rare neurological condition characterized by impaired eye movements, often resulting from brainstem lesions.
Observation:
- An 18-year-old male sustained a severe head injury from a traffic accident, presenting with altered consciousness and diagnosed with a left occipital skull fracture.
- Initial CT scans revealed extensive intracranial injuries including subdural hematoma, contusions, subarachnoid hemorrhage, and pneumocephalus.
- Two weeks post-injury, the patient developed symptoms consistent with bilateral MLF syndrome.
Findings:
- The patient was diagnosed with bilateral medial longitudinal fasciculus (MLF) syndrome following traumatic brain injury.
- Treatment included management of intracranial hemorrhage with barbiturates, dehydration, and steroids.
- The patient demonstrated significant improvement in MLF syndrome symptoms within one month.
Implications:
- This case highlights that traumatic brain injury, even without direct brainstem impact, can lead to bilateral MLF syndrome.
- Prompt diagnosis and management of associated intracranial pathologies are crucial for neurological recovery.
- Full recovery from traumatic bilateral MLF syndrome is possible, emphasizing the importance of comprehensive patient care.