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Washington University Experience | MYELIN (IMMUNE-MEDIATED) | ADEM | 2A0 Case 2 History
Case 2 History ---- The patient is a 65-year-old man with a 20-year history of diabetes, hypertension and chronic headaches. Roughly two weeks prior to admission (PTA) he had an upper respiratory infection with cough and congestion. Three nights PTA he had bouts of coughing on two occasions that led to emesis. The next morning, 2 days PTA, his wife noted that the left side of his mouth was drooping, his speech was slurred and slow and he had trouble dressing himself, but he was still able to walk. She thought he was having a stroke and brought him to the ER of an outside hospital. He had left hemiparesis on examination and a head CT showed vasogenic edema in the right frontal lobe. An MRI scan demonstrated diffuse high T2-weighted signal change with focal contrast enhancement within the frontoparietal lobes on the right with extension across the corpus callosum into the left hemisphere. There was some mild effacement of the right lateral ventricle but no discrete mass to suggest tumor. CSF analysis found elevated protein and a leukocytosis with neutrophilic predominance. Blood and CSF cultures were negative.
