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Washington University Experience | MYELIN (IMMUNE-MEDIATED) | ADEM | 3A0 Case 3 History
Case 3 History (Canadian Association of Neuropathology Unknowns 2004-Case 7) ---- This 76 year old man presented to a community hospital with a history of recent onset of urinary retention and constipation. Over the next 6 days he developed lower limb weakness and diminished sensation in his trunk and lower limbs. He was transferred to the reporting institution for further investigation. Neurological examination revealed asymmetric proximal lower limb weakness (grade 2 to 4), more preserved distal strength, bilateral up-going plantar responses and diminished sensation below a T8 level on the right and below T4 on the left. The neurological and general medical examinations were otherwise unremarkable. Imaging studies excluded spinal cord compression, but showed signal abnormalities within the upper thoracic cord that were initially interpreted as evidence of ischemic injury. Over the next 8 days there was a progressive return of lower limb strength almost to normal levels and more gradual recovery of sensation. However, on the day of planned transfer, the patient collapsed suddenly and died. Autopsy examination revealed a large ‘saddle’ pulmonary embolus. The spinal cord and brain were grossly unremarkable.
