{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T07:34:38Z","timestamp":1774424078728,"version":"3.50.1"},"reference-count":12,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,4,12]],"date-time":"2024-04-12T00:00:00Z","timestamp":1712880000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,4,12]],"date-time":"2024-04-12T00:00:00Z","timestamp":1712880000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Neurol"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Uraemia causes a generalised encephalopathy as its most common neurological complication. Isolated brainstem uraemic encephalopathy is rare. We report a case of fatigable ptosis and complex ophthalmoplegia in brainstem uraemic encephalopathy.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Case presentation<\/jats:title>\n                <jats:p>A 22-year-old Sri Lankan man with end stage renal failure presented with acute onset diplopia and drooping of eyelids progressively worsening over one week. The patient had not complied with the prescribed renal replacement therapy which was planned to be initiated 5\u00a0months previously. On examination, his Glasgow coma scale score was 15\/15, He had a fatigable asymmetrical bilateral ptosis. The ice-pack test was negative. There was a complex ophthalmoplegia with bilateral abduction failure and elevation failure of the right eye. The diplopia did not worsen with prolonged stare. The rest of the neurological examination was normal. Serum creatinine on admission was 21.81\u00a0mg\/dl. The repetitive nerve stimulation did not show a decremental pattern. Magnetic resonance imaging (MRI) of the brain demonstrated diffuse midbrain and pontine oedema with T2 weighted\/FLAIR hyperintensities. The patient was haemodialyzed on alternate days and his neurological deficits completely resolved by the end of the second week of dialysis. The follow up brain MRI done two weeks later demonstrated marked improvement of the brainstem oedema with residual T2 weighted\/FLAIR hyperintensities in the midbrain.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Uraemia may rarely cause an isolated brainstem encephalopathy mimicking ocular myasthenia, which resolves with correction of the uraemia.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12883-024-03626-y","type":"journal-article","created":{"date-parts":[[2024,4,12]],"date-time":"2024-04-12T09:02:14Z","timestamp":1712912534000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Uraemic brainstem encephalopathy mimicking ocular myasthenia: a case report"],"prefix":"10.1186","volume":"24","author":[{"given":"Pramith","family":"Ruwanpathirana","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thashi","family":"Chang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2024,4,12]]},"reference":[{"key":"3626_CR1","doi-asserted-by":"publisher","first-page":"810","DOI":"10.1136\/jnnp.65.6.810","volume":"65","author":"DJ Burn","year":"1998","unstructured":"Burn DJ, Bates D. Neurology and the kidney. J Neurol Neurosurg Psychiatry. 1998;65:810\u201321.","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"3626_CR2","doi-asserted-by":"publisher","first-page":"781","DOI":"10.1001\/archinte.1970.00310110051005","volume":"126","author":"HR Tyler","year":"1970","unstructured":"Tyler HR. Neurologic disorders seen in the uremic patient. Arch Intern Med. 1970;126:781\u20136.","journal-title":"Arch Intern Med"},{"key":"3626_CR3","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12883-017-0936-9","volume":"17","author":"LJ Jia","year":"2017","unstructured":"Jia LJ, Qu ZZ, Zhang XQ, Tian YJ, Wang Y. Uremic encephalopathy with isolated brainstem involvement revealed by magnetic resonance image: a case report. BMC Neurol. 2017;17:1\u20134.","journal-title":"BMC Neurol"},{"key":"3626_CR4","doi-asserted-by":"publisher","first-page":"391","DOI":"10.1159\/000188410","volume":"68","author":"U Can","year":"1994","unstructured":"Can U, Aydin P, Kansu T. Bilateral external ophthalmoplegia in uremia [4]. Nephron. 1994;68:391.","journal-title":"Nephron"},{"key":"3626_CR5","doi-asserted-by":"publisher","unstructured":"Popkov VA, Silachev DN, Zalevsky AO, Zorov DB, Plotnikov EY. Mitochondria as a Source and a Target for Uremic Toxins. Int J Mol Sci. 2019;20(12):3094. https:\/\/doi.org\/10.3390\/ijms20123094.","DOI":"10.3390\/ijms20123094"},{"key":"3626_CR6","doi-asserted-by":"publisher","first-page":"184","DOI":"10.1016\/j.neuro.2014.06.014","volume":"44","author":"K Watanabe","year":"2014","unstructured":"Watanabe K, Watanabe T, Nakayama M. Cerebro-renal interactions: impact of uremic toxins on cognitive function. Neurotoxicology. 2014;44:184\u201393.","journal-title":"Neurotoxicology"},{"key":"3626_CR7","doi-asserted-by":"publisher","first-page":"466","DOI":"10.1016\/j.kint.2019.10.032","volume":"97","author":"S Tanaka","year":"2020","unstructured":"Tanaka S, Okusa MD. Crosstalk between the nervous system and the kidney. Kidney Int. 2020;97:466\u201376.","journal-title":"Kidney Int"},{"key":"3626_CR8","doi-asserted-by":"publisher","first-page":"227","DOI":"10.1016\/j.kint.2021.09.025","volume":"101","author":"MH Rosner","year":"2022","unstructured":"Rosner MH, Husain-Syed F, Reis T, Ronco C, Vanholder R. Uremic encephalopathy. Kidney Int. 2022;101:227\u201341.","journal-title":"Kidney Int"},{"key":"3626_CR9","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1177\/2516608519848942","volume":"2","author":"D Gupta","year":"2019","unstructured":"Gupta D, Mehta A, Javali M, Acharya PT, Srinivasa R. Paramedian midbrain infarction presenting as bilateral asymmetric ptosis: a case report and review of literature. J Stroke Med. 2019;2:47\u20139.","journal-title":"J Stroke Med"},{"key":"3626_CR10","doi-asserted-by":"publisher","first-page":"e243220","DOI":"10.1136\/bcr-2021-243220","volume":"14","author":"S James","year":"2021","unstructured":"James S, Thozhuthumparambil KP. Brainstem stroke presenting as isolated bilateral ptosis. BMJ Case Reports CP. 2021;14:e243220.","journal-title":"BMJ Case Reports CP"},{"key":"3626_CR11","doi-asserted-by":"publisher","first-page":"1029","DOI":"10.1016\/S0025-6196(12)61726-1","volume":"66","author":"PW Brazis","year":"1991","unstructured":"Brazis PW. Localization of lesions of the oculomotor nerve: recent concepts. Mayo Clin Proc. 1991;66:1029\u201335.","journal-title":"Mayo Clin Proc"},{"key":"3626_CR12","doi-asserted-by":"publisher","first-page":"1604","DOI":"10.3174\/ajnr.A4776","volume":"37","author":"DM Kim","year":"2016","unstructured":"Kim DM, Lee IH, Song CJ. Uremic Encephalopathy: MR Imaging Findings and Clinical Correlation. AJNR Am J Neuroradiol. 2016;37:1604.","journal-title":"AJNR Am J Neuroradiol"}],"container-title":["BMC Neurology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12883-024-03626-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12883-024-03626-y\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12883-024-03626-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,4,12]],"date-time":"2024-04-12T09:06:20Z","timestamp":1712912780000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcneurol.biomedcentral.com\/articles\/10.1186\/s12883-024-03626-y"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,4,12]]},"references-count":12,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["3626"],"URL":"https:\/\/doi.org\/10.1186\/s12883-024-03626-y","relation":{},"ISSN":["1471-2377"],"issn-type":[{"value":"1471-2377","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,4,12]]},"assertion":[{"value":"11 December 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"8 April 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 April 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Informed written consent was obtained from the index patient for publishing the clinical details and photographs after anonymising. Approval from an ethics review committee was not sought as the publication is a case report.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"121"}}