OBJECTIVE

To present a rare case of nine syndrome in a middle-aged patient with stage IV chronic kidney disease presenting with hypertensive emergency at a tertiary government hospital, and to discuss its clinical presentation, diagnostic approach, and management within the realities of limited-resource settings.

METHODS

This is a case report.

RESULTS

A 45-year-old woman with uncontrolled hypertension and stage IV chronic kidney disease came to the emergency department with acute dizziness and vomiting. On neurologic examination, she had left horizontal conjugate gaze palsy and an adduction deficit of the left eye with intact abduction and an abducting nystagmus of the right eye consistent with one-and-a-half syndrome. In addition, she had left-sided facial weakness and right lower limb weakness suggesting nine syndrome. Brain imaging confirmed a left posterior pontine infarct. Treatment for neuroprotection and blood pressure control led to significant improvement in ocular symptoms and muscle strength.

CONCLUSION

This report describes a rare case of nine syndrome. Careful bedside neuro-ophthalmologic examination, supported by MRI, enabled accurate localization to the paramedian pons. Early recognition allowed timely stroke management and initiation of secondary management, even in a resource-limited setting.

Human ; Female ; Middle Aged: 45-64 Yrs Old ; Hypertensive Emergency ; Hypertensive Crisis

Pediatric intracerebral hemorrhage is a rare condition among children. We discuss the case of a 7-year-old Filipino male with generalized tonic seizures and diagnosed to have both SARS-CoV-2 infection and hypertension secondary to renal arterial stenosis. The occurrence of intracerebral hemorrhage in children, though commonly caused by arteriovenous malformations, may be secondary to an acute hypertensive episode. In this case, the presence of COVID-19 in the patient may have been contributory to the development of spontaneous intracerebral hemorrhage due to its direct endothelial effects, as well as its dysregulatory action on the renin-angiotensin-aldosterone system.
COVID-19 ; Hypertensive Crisis ; Renal Artery Obstruction