A 41-year-old man with progressive quadriparesis

Slides:

Advertisements

Similar presentations

Teaching NeuroImages Neurology Resident and Fellow Section © 2014 American Academy of Neurology A 74 year-old woman with cerebral edema after myelography.

Advertisements

A 15 YEAR OLD BOY WITH AN ASCENDING SPASTIC PARALYSIS Teaching Video NeuroImages Neurology Resident and Fellow Section © 2013 American Academy of Neurology.

63 year-old woman with subacute parkinsonism Teaching NeuroImages Neurology Resident and Fellow Section © 2014 American Academy of Neurology.

Teaching NeuroImages Neurology Resident and Fellow Section © 2013 American Academy of Neurology Neonatal Parechovirus Encephalitis: Typical MRI findings.

A 41 year old African patient with „multifocal neurology“ Teaching NeuroImages Neurology Resident and Fellow Section © 2013 American Academy of Neurology.

A 52-year old man with recently diagnosed HIV infection with irregular shaking of his hand Teaching NeuroImages Neurology Resident and Fellow Section ©

A 62-year-old man presented with mild left hemiparesis, headache and blurred vision of his right eye Teaching NeuroImages Neurology Resident and Fellow.

A TWO YEAR OLD GIRL WITH PROGRESSIVE WEAKNESS Teaching NeuroImages Neurology Resident and Fellow Section © 2014 American Academy of Neurology.

A 62-year-old man with progressive action tremor and a 74-year-old man with progressive ataxia Teaching NeuroImages Neurology Resident and Fellow Section.

Acute neck pain and quadriparesis An 82 year old man with acute neck pain Teaching NeuroImages Neurology Resident and Fellow Section © 2014 American Academy.

48-year-old man with ascending sensory deficits Teaching NeuroImages Neurology Resident and Fellow Section © 2014 American Academy of Neurology.

A 68 year old woman with a troublesome chin tremor Teaching NeuroImages Neurology Resident and Fellow Section © 2013 American Academy of Neurology.

Neurology Resident and Fellow Section 40 year old woman with left arm pain, numbness, and weakness Teaching NeuroImages © 2013 American Academy of Neurology.

A 43-year-old man with decreased consciousness Teaching NeuroImages Neurology Resident and Fellow Section © 2014 American Academy of Neurology.

Teaching NeuroImages Neurology Resident and Fellow Section © 2013 American Academy of Neurology A 35-year-old woman with headache and diplopia.

Teaching NeuroImages Neurology Resident and Fellow Section © 2013 American Academy of Neurology A 54 year old man with progressive apathy and cognitive.

A 38-year-old patient with partial seizures Teaching NeuroImages Neurology Resident and Fellow Section © 2014 American Academy of Neurology.

47-year-old with progressive upper limb weakness Teaching NeuroImages Neurology Resident and Fellow Section © 2014 American Academy of Neurology.

Teaching NeuroImages Neurology Resident and Fellow Section © 2013 American Academy of Neurology An unusual cause of conus medullaris syndrome.

Teaching NeuroImages Neurology Resident and Fellow Section © 2013 American Academy of Neurology Cerebral White Matter Involvement in a Patient with Bilateral.

68 year old man with aphasia and facial droop © 2014 American Academy of Neurology Teaching NeuroImages Neurology Resident and Fellow Section.

A 22 years old man with slow movements and mounding phenomenon © 2013 American Academy of Neurology Teaching NeuroImages Neurology Resident and Fellow.

Progressive fetal intracranial lesion Teaching NeuroImages Neurology Resident and Fellow Section © 2015 American Academy of Neurology.

67-old man with 45-min onset left hemiparesis Teaching NeuroImages Neurology Resident and Fellow Section © 2015 American Academy of Neurology.

6-year-old boy with progressive neurologic decline Teaching NeuroImages Neurology Resident and Fellow Section © 2015 American Academy of Neurology.

A 71 year old man with rapid onset of anterograde amnesia Teaching NeuroImages Neurology Resident and Fellow Section © 2015 American Academy of Neurology.

Teaching NeuroImages Neurology Resident and Fellow Section A 51 year old female with intermittent left hand numbness and weakness. © 2013 American Academy.

Teaching NeuroImages Neurology Resident and Fellow Section Spherules in Spine: Vertebral Coccidioidomycosis © 2014 American Academy of Neurology.

Teaching NeuroImages Neurology Resident and Fellow Section © 2013 American Academy of Neurology Two sisters with scapular winging.

A 35-year-old patient with motor aphasia Teaching NeuroImages Neurology Resident and Fellow Section © 2013 American Academy of Neurology.

A 58 year old woman with acute-onset paresthesias

Neurology Resident and Fellow Section

71-year-old Man with Nystagmus and Oscillpsia

Neurology Resident and Fellow Section

Neurology Resident and Fellow Section

A 54-year-old man with acute-onset diplopia and weakness

Hemigeographic tongue following an acute ischemic stroke

A 15 YEAR OLD BOY WITH AN ASCENDING SPASTIC PARALYSIS

36-year-old woman with persistent spinning vertigo, diplopia

55 year-old man with acute headache and dizziness Teaching NeuroImages Neurology Resident and Fellow Section David Yen-Ting Chen, MD Ying-Chi Tseng, MD.

Teaching Video NeuroImages Neurology Resident and Fellow Section

A 22-year-old woman with progressive ataxia and feet dystonia

Neurology Resident and Fellow Section

Progressive jerky movements in a 58 year old man

A 54-year old woman with subacute encephalopathy

Neurology Resident and Fellow Section

A 52-year-old woman with abnormal eye movements

Acquired hepatocerebral degeneration

A 60 year-old male with vertigo, dysarthria and weakness

Rupture and spontaneous resolution of a P1 perforator pseudoaneurysm

Abnormal movements in an unconscious adult Teaching NeuroImages Neurology Resident and Fellow Section © 2018 American Academy of Neurology.

68-year-old patient with memory impairment

A 7 month old boy with Glutaric Aciduria and flexor spells

A 21 year old woman with frequent vomiting

Neurology Resident and Fellow Section

A 56 YEAR OLD MAN WITH TRANSIENT VISUAL LOSS

A 33 year old woman with chronic dizziness

Acute bilateral ptosis in an 82-year old man

Figure 1 Cerebral MRI during the disease course Cerebral MRI with multiple cerebral supratentorial lesions during the disease course: periventricular lesions.

20 year old man with multiple strokes territories

Neurology Resident and Fellow Section

Neurology Resident and Fellow Section

Figure Spinal cord imaging (A, B) Sagittal and axial T2-weighted cervical spine MRI demonstrating hyperintensities in the central gray matter of patient.

A 2 year old girl with progressive neurological deficits

A 16-year-old boy with intractable epilepsy

A 11-month-old girl with acute irritability and hypotonia

63 year old female in coma status post occipital craniectomy

Teaching NeuroImages Neurology Resident and Fellow Section

Teaching NeuroImages Neurology Resident and Fellow Section

A 3-year-old boy with increased head circumference

Presentation transcript:

A 41-year-old man with progressive quadriparesis Teaching NeuroImages Neurology Resident and Fellow Section © 2017 American Academy of Neurology

Vignette A 41-year-old man with progressive quadriparesis and generalized tingling sensation showed spontaneous upbeating nystagmus and horizontal gaze-evoked nystagmus. Lee, et al. © 2017 American Academy of Neurology

Imaging Figure. Initial and follow-up MRIs. Diffusion-weighted images obtained six hours after symptom onset did show an equivocal hyperintensity in the rostral medial medulla oblongata (upper row). Follow-up images obtained two days later exhibit a “heart appearance” sign extending to the dorsal medulla (lower row). Lee, et al. © 2017 American Academy of Neurology

Video Video. The video shows spontaneous upbeat and horizontal gaze-evoked nystagmus. The upbeat nystagmus was predominant during visual fixation. Horizontal gaze-evoked nystagmus was induced during bilateral gaze. The upbeat nystagmus was increased during upward and bilateral gaze and decreased during downward gaze. LH=horizontal position of the left eye, LV=vertical position of the left eye, LT=torsional position of the left eye. Lee, et al. © 2017 American Academy of Neurology

Upbeat and Horizontal Gaze-evoked Nystagmus in Bilateral Medial Medullary Infarction Since motor weakness can be progressively presented and the MRI findings can be equivocal in the acute stage of bilateral medial medullary infarction, patients who have progressive quadriplegia with normal consciousness may be misdiagnosed as Guillain-Barre syndrome or its variants. The nystagmus suggesting a central origin may be helpful for early diagnosis in this setting. REFERENCES 1. Pongmoragot J, Parthasarathy S, Selchen D, Saposnik G. Bilateral medial medullary infarction: a systematic review. J Stroke Cerebrovasc Dis 2013;22:775–780. 2. Ma L, Deng Y, Wang J, Du F, Xia F, Liu Y, Li X. (2011). Bilateral medial medullary infarction presenting as Guillain-Barré-like syndrome. Clin Neurol Neurosurg 2011;113:589–591. Lee, et al. © 2017 American Academy of Neurology