A 62-year-old man with fluctuating neurological deficits and skin lesions

John J. Konikkara, Osvaldo H. Perurena, Steven Warach, Steven C. Bauserman

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

A 62-year-old man with no significant medical history experienced fatigue, night sweats, hoarseness of voice, and dry cough, which were followed by vision disturbances in his left eye. He lost about 4.5 kg (10 lb) in just over a month. Three weeks later, he had difficulty recollecting his e-mail password and trouble with word finding. The next day, he experienced numbness in his left arm. He also developed a maculopapular and erythematous rash in the groin, genitalia, and buttocks. The results of an initial neurological examination were normal, including his higher mental functions. An initial blood workup revealed normocytic normochromic anemia. The results of cerebrospinal fluid studies were unremarkable. Magnetic resonance imaging of his brain at hospital admission revealed multifocal increased T2 signals in the subcortical white matter. A conventional cerebral angiogram was unremarkable. A biopsy specimen from the right frontal lobe revealed demyelination and perivascular lymphocytic infiltration. A provisional diagnosis of acute disseminated encephalomyelitis was made. In spite of steroid treatment and plasmapheresis, his clinical status deteriorated rapidly. The approach to the diagnosis of a rapidly progressive multifocal brain disorder is discussed.

Original languageEnglish (US)
Pages (from-to)120-124
Number of pages5
JournalArchives of Neurology
Volume70
Issue number1
DOIs
StatePublished - Jan 2013

Fingerprint

Acute Disseminated Encephalomyelitis
Hoarseness
Skin
Buttocks
Genitalia
Plasmapheresis
Hypesthesia
Sweat
Groin
Neurologic Examination
Postal Service
Brain Diseases
Frontal Lobe
Demyelinating Diseases
Exanthema
Cough
Fatigue
Cerebrospinal Fluid
Anemia
Angiography

ASJC Scopus subject areas

  • Clinical Neurology
  • Arts and Humanities (miscellaneous)

Cite this

Konikkara, J. J., Perurena, O. H., Warach, S., & Bauserman, S. C. (2013). A 62-year-old man with fluctuating neurological deficits and skin lesions. Archives of Neurology, 70(1), 120-124. https://doi.org/10.1001/2013.jamaneurol.469

A 62-year-old man with fluctuating neurological deficits and skin lesions. / Konikkara, John J.; Perurena, Osvaldo H.; Warach, Steven; Bauserman, Steven C.

In: Archives of Neurology, Vol. 70, No. 1, 01.2013, p. 120-124.

Research output: Contribution to journalArticle

Konikkara, JJ, Perurena, OH, Warach, S & Bauserman, SC 2013, 'A 62-year-old man with fluctuating neurological deficits and skin lesions', Archives of Neurology, vol. 70, no. 1, pp. 120-124. https://doi.org/10.1001/2013.jamaneurol.469
Konikkara, John J. ; Perurena, Osvaldo H. ; Warach, Steven ; Bauserman, Steven C. / A 62-year-old man with fluctuating neurological deficits and skin lesions. In: Archives of Neurology. 2013 ; Vol. 70, No. 1. pp. 120-124.
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