Table of Contents
Washington University Experience | MYELIN (IMMUNE-MEDIATED) | AHL | AHL, Brainstem - Spinal Cord Predominant Case | 1A0 Case 1 History
Case 1 History ---- The patient was a 49 year old farmer in good health throughout his life until he suddenly developed frontal headache, fever, vomiting, and pain in the thoracolumbar area. He awoke after a nap to find that his legs had suddenly become numb and weak. He had apparently received a "flu" shot from his family physician approximately 10 days previously. On initial examination he was an alert, afebrile cooperative man with an intact intellect, normal cranial nerves, flaccid paraparesis and a distended bladder. Strength, coordination, and sensation were intact in the arms; however, his legs were flaccid with only trace movement and there was decreased pain sensation below T7 bilaterally. Early on vibration and position were preserved except for a mild loss in position sense over the left toes. They were only trace tendon reflexes in the legs. Anal wink, plantar reflexes and cremasteric reflexes were absent. An emergency myelogram was performed that night and was normal. CSF showed protein 128, glucose 58, 58 segs, 2 monos, 20 lymphs, and 20 plasmacytoid cells. He was thought to have a transverse myelopathy of unknown origin and started on treatment with penicillin. Thirty-six hours after the onset of the paraparesis, he developed marked nausea and vomiting and rapidly progressed to a stuporous state with respiratory distress. He became progressively more unresponsive with decerebrate posturing over the next 8 hours. He was maintained on a respirator for the last 24 hours of life, and was treated with numerous antibiotics and Decadron without any improvement. A repeat LP showed an opening pressure of 245, protein 142, glucose 62, white blood cell count 128 (33 polys, 39 lymphs, 12 monos, and 15 plasmacytoid cells). Viral serologies (mumps, Coxsackie, rubella, herpes, varicella, lymphocytic choriomeningitis, adenovirus, influenza) were negative. He developed hypotension and poor left ventricular function culminating in cardiorespiratory arrest and was pronounced dead 50 hrs after admission.
