Acute Onset Asymmetric Sensorimotor Paraparesis: Not Always Spinal!

Dhananjay Gupta, P. R, A. Mehta, M. Javali, P. T. Acharya, R. Srinivasa
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Abstract

Abstract Objective: To report an atypical case of acute onset sensorimotor paraparesis secondary to bilateral cerebral stroke. Background: Acute onset paraparesis or paraplegia is usually secondary to a spinal cord disease. Central or cerebral causes of paraparesis are rare and include parasagittal and bilateral precentral lesions. Design/Methods: Case report and literature review. Results: A 65-year-old man presented with acute onset weakness of both lower limbs, associated with pins and needle sensation. On examination, he was found to have paraparesis (grade 2/5, both legs) and an asymmetric sensory loss in both legs and thighs. Spinal magnetic resonance imaging ruled out any compressive or noncompressive etiology. Magnetic resonance imaging of the brain showed an acute infarction in the bilateral cerebral hemisphere in both the pre- and postcentral gyrus. An angiogram of the brain revealed an aplastic right ACA-A1 with left ACA-A1 feeding bilateral A2. There was distal left ACA-A1 stenosis seen, the probable cause of bilateral stroke in this patient. The patient was treated conservatively and showed symptomatic improvement during the course of stay at the hospital. Conclusion: This case of acute paraparesis secondary to bilateral cerebral infarction demonstrates the need to always look for a cerebral cause. In patients with cerebral infarction, who present early to a hospital, it may provide a window for thrombolytic or endovascular therapy.
急性不对称感觉运动截瘫:并不总是脊柱!
摘要目的:报告1例双侧脑卒中继发急性感觉运动截瘫的不典型病例。背景:急性截瘫或截瘫通常继发于脊髓疾病。中枢性或脑性麻痹的原因是罕见的,包括旁矢状突和双侧中央前病变。设计/方法:病例报告和文献回顾。结果:一名65岁男性表现为急性发作的双下肢无力,与针和针刺感有关。经检查,发现患者有下肢旁瘫(2/5级,双腿),双腿和大腿不对称感觉丧失。脊髓磁共振成像排除了任何压缩性或非压缩性病因。脑磁共振成像显示双侧大脑半球中央前回和后回均有急性梗死。脑血管造影显示右侧ACA-A1再生,左侧ACA-A1喂养双侧A2。左侧远端ACA-A1狭窄,可能是该患者双侧卒中的原因。患者接受保守治疗,在住院期间症状有所改善。结论:本病例继发于双侧脑梗死的急性截瘫表明需要始终寻找脑病因。在早期到医院就诊的脑梗死患者中,这可能为溶栓或血管内治疗提供了一个窗口期。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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