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A patient with altered consciousness and spastic quadriplegia
Journal of Clinical Neuroscience 18 (2011) 540
Contents lists available at ScienceDirect
Journal of Clinical Neuroscience journal homepage: www.elsevier.com/locate/jocn
Images in Neuroscience: Question
A patient with altered consciousness and spastic quadriplegia Hung Youl Seok a, Sung Won Youn b, Ki-Young Jung a,⇑ a b
Department of Neurology, Korea University Medical Center, Korea University College of Medicine, #126-1, Anam-Dong 5 Ga, Seongbuk-Gu, Seoul 136-705, Republic of Korea Department of Radiology, Korea University Medical Center, Korea University College of Medicine, Seoul, Republic of Korea
1. Clinical background A 36-year-old man presented with mental status changes, seizures, and a fever. His cerebrospinal fluid (CSF) was a yellowish color, contained 4,900 white blood cells/uL (99% neutrophils), and 1,151 mg/dL protein, and he had a CSF/serum glucose ratio of 0.25. A clinical diagnosis of bacterial meningitis was made based on his clinical history and CSF findings. Nine hours after symptom onset, sudden cardiopulmonary arrest occurred of unknown etiology. Although the patient was successfully resuscitated, he remained in a stuporous state with spastic quadriplegia. The patient was initially fed by total parenteral nutrition for 12 days,
and then via a nasogastric tube. Twenty-six days after presentation, a brain MRI was performed (Fig. 1). 2. What is the most likely diagnosis? A. B. C. D. E.
Wernicke’s encephalopathy Hypoxic-ischemic encephalopathy Hypoglycemic encephalopathy Central pontine and extrapontine myelinolysis Creutzfeldt-Jacob disease (CJD)
Answer on page 591.
Fig. 1. Axial brain MRI obtained at 26 days after cardiopulmonary arrest and resuscitation: (A, D) fluid-attenuated inversion recovery MRI showing increased signal intensity in the cerebral and cerebellar cortices, substantia nigra, hippocampi and periaqueductal gray matter (white arrow); (B, E) pre-contrast T1-weighted MRI showing hyperintensity of the temporo-occipital cortex, suggestive of cortical laminar necrosis, and deep gray matter; and (C, F) post-contrast T1-weighted MRI showing thin gyral enhancement of the cerebral cortices.
⇑ Corresponding author. Tel.: +82 2 920 6649; fax: +82 2 925 2472. E-mail address: [email protected] (K.-Y. Jung). 0967-5868/$ - see front matter Ó 2010 Elsevier Ltd. All rights reserved. doi:10.1016/j.jocn.2010.03.006
Contents lists available at ScienceDirect
Journal of Clinical Neuroscience journal homepage: www.elsevier.com/locate/jocn
Images in Neuroscience: Question
A patient with altered consciousness and spastic quadriplegia Hung Youl Seok a, Sung Won Youn b, Ki-Young Jung a,⇑ a b
Department of Neurology, Korea University Medical Center, Korea University College of Medicine, #126-1, Anam-Dong 5 Ga, Seongbuk-Gu, Seoul 136-705, Republic of Korea Department of Radiology, Korea University Medical Center, Korea University College of Medicine, Seoul, Republic of Korea
1. Clinical background A 36-year-old man presented with mental status changes, seizures, and a fever. His cerebrospinal fluid (CSF) was a yellowish color, contained 4,900 white blood cells/uL (99% neutrophils), and 1,151 mg/dL protein, and he had a CSF/serum glucose ratio of 0.25. A clinical diagnosis of bacterial meningitis was made based on his clinical history and CSF findings. Nine hours after symptom onset, sudden cardiopulmonary arrest occurred of unknown etiology. Although the patient was successfully resuscitated, he remained in a stuporous state with spastic quadriplegia. The patient was initially fed by total parenteral nutrition for 12 days,
and then via a nasogastric tube. Twenty-six days after presentation, a brain MRI was performed (Fig. 1). 2. What is the most likely diagnosis? A. B. C. D. E.
Wernicke’s encephalopathy Hypoxic-ischemic encephalopathy Hypoglycemic encephalopathy Central pontine and extrapontine myelinolysis Creutzfeldt-Jacob disease (CJD)
Answer on page 591.
Fig. 1. Axial brain MRI obtained at 26 days after cardiopulmonary arrest and resuscitation: (A, D) fluid-attenuated inversion recovery MRI showing increased signal intensity in the cerebral and cerebellar cortices, substantia nigra, hippocampi and periaqueductal gray matter (white arrow); (B, E) pre-contrast T1-weighted MRI showing hyperintensity of the temporo-occipital cortex, suggestive of cortical laminar necrosis, and deep gray matter; and (C, F) post-contrast T1-weighted MRI showing thin gyral enhancement of the cerebral cortices.
⇑ Corresponding author. Tel.: +82 2 920 6649; fax: +82 2 925 2472. E-mail address: [email protected] (K.-Y. Jung). 0967-5868/$ - see front matter Ó 2010 Elsevier Ltd. All rights reserved. doi:10.1016/j.jocn.2010.03.006