Search

Cerebral venous thrombosis commonly presents with headache, seizure, and motor weakness. Among cranial nerves, the abducens nerve is common to get involved. We report a patient who had cerebral venous sinus thrombosis involving superior sagittal sinus, right lateral sinus, and right internal jugular vein and presented with bilateral lower motor neuron (LMN) facial palsy besides bilateral abducens nerve palsy and bilateral optic nerve involvement in the form of papilledema. A few cases of cerebral venous thrombosis involving lateral sinus with ipsilateral LMN facial nerve palsy have been reported. Our case highlights the rare occurrence of bilateral LMN facial palsy with unilateral lateral sinus involvement.

Objectives: The protein-sparing modified fast (PSMF) is a rigorous way of rapidly losing a large amount of weight. Although adult studies have shown the PSMF to be effective, data in adolescents are lacking. The aim of this study was to determine the efficacy and safety of the PSMF in severely obese adolescents. Methods: 12 subjects who were evaluated in the Obesity Management Program at the Cleveland Clinic from 2011 to 2014 were included. The subjects were initiated on the PSMF after failing other conventional methods of weight loss. Once the goal weight was achieved, subjects were transitioned to the refeeding phase for weight maintenance. Results: Follow-up was scheduled at 3-month (11 patients) and 6-month (6 patients) intervals. At the 6-month follow-up visit, the average weight loss was 11.19 kg (95% confidence interval = -5.4, -27.8, P = .028), with average of 9.8% from baseline. Fifty percent of subjects had >5% weight loss and 20% had >10% weight loss. Four patients were lost to the follow-up (40%). An improvement was noted in total cholesterol and high-density lipoprotein. Due to a small sample size these results were not statistically significant. Side effects reported by subjects were mild dehydration due to nausea (2 patients), decreased energy (1 patient), and transient labile mood (1 patient). No life-threatening side effects were reported. Conclusion: Our results show that the PSMF diet can be used as an effective and safe method in the outpatient setting for rapid weight loss in adolescents with severe obesity.