Case report: subacute tetraplegia in an immunocompromised patient. Issue 1 (December 2017)

• Record Type: Journal Article
• Authors: Zeller, Daniel; Heidemeier, Anke; Grigoleit, Götz; Müllges, Wolfgang
• Is Part Of: BMC neurology. Volume 17:Issue 1(2017)
• Page Start: 1
• Page End: 3
• Publication Date: 2017-12
• Subjects: Tetraparesis -- Motor cortex -- CMV encephalitis -- Case report; Neurology -- Periodicals; 616.8005
• DOI: 10.1186/s12883-017-0814-5
• Languages: English
• ISSNs: 1471-2377

Abstract

Abstract Background Clinical reasoning in Neurology is based on general associations which help to deduce the site of the lesion. However, even "golden principles" may occasionally be deceptive. Here, we describe the case of subacute flaccid tetraparesis due to motor cortical lesions. To our knowledge, this is the first report to include an impressive illustration of nearly symmetric motor cortical involvement of encephalitis on brain MRI. Case presentation A 51 year old immunocompromized man developed a high-grade pure motor flaccid tetraparesis over few days. Based on clinical presentation, critical illness polyneuromyopathy was suspected. However, brain MRI revealed symmetrical hyperintensities strictly limited to the subcortical precentral gyrus. An encephalitis, possibly due to CMV infection, turned out to be the most likely cause. Conclusion While recognition of basic clinical patterns is indispensable in neurological reasoning, awareness of central conditions mimicking peripheral nervous disease may be crucial to detect unsuspected, potentially treatable conditions.