Case report: subacute tetraplegia in an immunocompromised patient

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 i...

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Bibliographic Details
Published in:BMC neurology 2017-02, Vol.17 (1), p.31-31, Article 31
Main Authors: Zeller, Daniel, Heidemeier, Anke, Grigoleit, Götz Ulrich, Müllges, Wolfgang
Format: Article
Language:English
Subjects:
Case Report
Cytomegalovirus Infections
Encephalitis - diagnosis
Encephalitis - immunology
Humans
Immunocompromised Host
Magnetic Resonance Imaging
Male
Middle Aged
Quadriplegia - immunology
Quadriplegia - virology
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Summary: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. 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. 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.
ISSN:1471-2377
1471-2377
DOI:10.1186/s12883-017-0814-5