A 66-year-old patient with progressive left hemiparesis: Answer

摘要

A 66-year-old man developed sub-acute progressive left hemi-paresis. On admission, he had dysarthric speech, spastic left hemi-paresis with bilateral pyramidal signs and left hand deafferentation. MRI showed two distinct lesions, one involving the brainstem and cerebellum with diffuse swelling but without contrast enhancement (Fig. 1 A, B), with the other being an enhancing lesion affecting the spinal cord between C6-T3 levels (Fig. 1C, D). Lumbar puncture revealed 83 white blood cells/mm3, mostly polymorphonuclear cells, with a protein level of 235 mg/dl (normal < 40 mg/dl) and normal glucose level. Oligoclonal bands were absent, and cytologi-cal examination was negative for malignant cells. Two consecutive lumbar punctures provided similar results.