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A mystery solved
  1. H Abbasi1,
  2. S L Bell2,
  3. W Stewart2,
  4. Asha Neelakantan3,
  5. Stewart Webb1
  1. 1Department of Neurology, Institute of Neurological Sciences, Southern General Hospital, Glasgow, UK
  2. 2Department of Neuropathology, Institute of Neurological Sciences, Southern General Hospital, Glasgow, UK
  3. 3Department of Neuroradiology, Institute of Neurological Sciences, Southern General Hospital, Glasgow, UK
  1. Correspondence to Dr Hina Naz Abbasi, Department of Neurology, Institute of Neurological Sciences, Southern General Hospital, 1345 Govan Road, Glasgow G51 4TF, Scotland; hina.abbasi{at}nhs.net

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Case report

A 58-year-old man initially noticed an abnormal sensation around the abdomen and weakness of the legs, making it difficult for him to finish a round of golf. Two months later, he developed sudden weakness of the left face and hand, with abnormal sensation of the upper lip. He was admitted to the local hospital. An MR scan of brain showed an acute infarction in the right centrum semiovale; he was started on stroke prevention therapy. One month later, he was re-admitted with a 2-week history of gradual onset bilateral lower limb weakness, paraesthesia and urinary retention. MR scan of spine showed a hyperintense contrast-enhancing, intramedullary lesion between T6 and T10, thought to represent either ischaemia or demyelination (figure 1). Despite starting corticosteroids, he continued to deteriorate, with complete flaccid paraplegia, night sweats and pyrexia.

Figure 1

MR scan of spine (sagittal T2W) showing subtle focal anterior cord hyperintensity.

His erythrocyte sedimentation rate and serum C reactive protein were …

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