OBJECTIVE

To describe the clinical presentation, management and outcome of a rare case of isolated oculomotor nerve palsy in an immunocompromised adult secondary to a central nervous system (CNS) tuberculoma.

METHODS

This is a case report.

RESULTS

A Filipino male in his 30s developed severe throbbing headache followed by binocular diplopia and drooping of the right upper eyelid. Findings were compatible with a neurologically-isolated pupil-involving, complete oculomotor nerve palsy on the right. Brain magnetic resonance imaging demonstrated enlargement and contrast enhancement of the cisternal portion of the right oculomotor nerve. Serologic testing was positive for the human immunodeficiency virus (HIV) and syphilis. Cerebrospinal fluid (CSF) analysis showed lymphocytic pleocytosis and elevated protein. CSF polymerase chain reaction was positive for Mycobacterium tuberculosis (TB). The patient was treated with penicillin, quadruple anti-Koch’s, and anti-retrovirals. Eyelid position and ocular motility improved after treatment. Aberrant regeneration of the right oculomotor nerve was observed with elevation of the right eyelid on downgaze (pseudo-Graefe sign).

CONCLUSION

CNS tuberculoma may present as a neurologically-isolated oculomotor nerve palsy, particularly in immunocompromised individuals. In TB-endemic countries, like the Philippines, it should be considered in the differential diagnosis. Early recognition and appropriate antimicrobial therapy can lead to neurologic improvement.

Human ; Male ; Adult: 25-44 Yrs Old ; Oculomotor Nerve Palsy ; Oculomotor Nerve Diseases ; Tuberculoma ; Hiv ; Syphilis ; Diplopia

Background and Objective: Neuroanatomy is both terrifying to learn and problematic to teach, and the different methods of neuroanatomical education have their own strengths and weaknesses. In this cross-sectional study, we evaluated the perception of undergraduate medical students towards the combined use of plastinated and formalinpreserved brain specimen in their neuroanatomy course. Methods: A bridging program was designed for students whose medical education was interrupted by the COVID-19 pandemic in order to reinforce the knowledge and understanding of anatomy that they acquired in a virtual environment. A total of 175 first year medical students participated in this learning activity, which included seven stations in neuroanatomy spread across two hours, and covered the anatomy of the circle of Willis, brainstem, cranial nerves, spinal cord, internal cerebrum, and external cerebrum. To evaluate short-term learning, the students were asked to take a quiz containing 10 multiple-choice questions before and after the learning activity. In addition, the students also answered a survey containing 11 Likert-type questions asking about their perception of the learningactivity. Results: Following the learning activity, mean test scores increased from 4.73 (SD 1.74) to 5.32 (SD 1.52; mean difference 0.59, p = 0.008). Majority of the students (mean 81%, range 43-93%) had a neutral or positive perception of plastinated brain specimen, and on factor analysis, plastinated brain specimen were found to be both practical and useful for learning neuroanatomy. However, the participants perceived plastinated brain specimen alone to be insufficient for learning neuroanatomy, and a multimodal approach to learning neuroanatomy is ideal. Conclusion Plastinated brain specimens were found to be an effective complement to formalin-preserved brain, and these should be used by medical schools when designing neuroanatomy learning activities for their students.
Neuroanatomy

Background and Objective: The pandemic acted as an accelerator for the development of online teaching formats in anatomy and histology worldwide. The authors introduce a bridging program that reinforces the knowledge and understanding of gross and correlative anatomy and histology acquired in a virtual environment in preparation for its future clinical application. The study aims to evaluate the Learning Enhancement in Anatomy Program (LEAP) conducted among first-year medical students at the College of Medicine, University of the Philippines Manila. Methods: This descriptive cross-sectional study aims to determine the initial experience of implementing a learning enhancement program and assess areas for its improvement. An internally validated questionnaire was given to students after the program to gauge students’ reactions (Kirkpatrick Level 1 evaluation). Pre- and post-tests were administered to evaluate knowledge acquisition (Kirkpatrick Level 2 evaluation). Short-term behavioral peer evaluation (Kirkpatrick Level 3 evaluation) was also instituted. Results: One hundred fifty-two (152) students participated in the study. General reactions from students to the LEAP were consistently positive, with a steady majority of the students rating ‘5’ or a ‘Strongly Agree’ to positive statements regarding the program. Higher ratings for more traditional teaching methods, such as cadavers, formalinized specimens, and bones, compared to virtual systems were apparent. However, inter-student variation in preference for teaching modalities was observed. All stations of the LEAP were evaluated satisfactorily, with most gross anatomy stations rated higher than histology stations. A significant increase was noted in the total post-test scores compared to pre-test scores. This improvement in test scores was observed in the anatomy and histology subcategories and in six of the seven organ system modules. Perceived behavioral outcomes were also generally positive. Conclusion The LEAP is a worthwhile endeavor, garnering overwhelmingly positive reactions and a significant improvement in test scores. Future studies are necessary to fine-tune teaching and training in a blended learning environment.
Anatomy ; COVID-19 ; Education, Medical ; Program Evaluation

BACKGROUND: Uncontrolled hypertension in acute intracerebral hemorrhages (ICH) may cause hematoma expansion within the first 24 hours, and increase patient mortality. We investigated whether there was an association between ICH location and the difficulty in lowering BP in patients with acute hypertensive non- lobar ICH.

METHODS: This is a retrospective cohort study of adults diagnosed with non-lobar ICH admitted at a tertiary hospital over a 2-year period. We documented the time to attain target mean arterial pressure (MAP) of 110-130 mmHg, as well as the use of antihypertensive medications.

RESULTS: Of 357 patients admitted for non-lobar ICH,47 patients fulfilled the study criteria. Basal ganglia hemorrhages were the most common (47%), followed by thalamic (34%), cerebellar (11%), and pontine hemorrhages (8%). While there were no significant differences in baseline MAP among the different sites of hemorrhage, those with thalamic ICH had a significantly longer time-to-target MAP (p=0.02) and required three or more classes of oral antihypertensive medications (p

CONCLUSIONS: Acute thalamic intracerebral hemorrhages may require multiple classes of antihypertensives to lower blood pressure to safer levels.

Human ; Male ; Female ; Middle Aged ; .humans ; Adult ; Antihypertensive Agents ; Blood Pressure ; Tertiary Care Centers ; Retrospective Studies ; Basal Ganglia Hemorrhage ; Cerebral Hemorrhage ; Hypertension ; Hematoma