Clinical Features of Demyelinating Lesion in Medulla Oblongata and Cervical Cord Junction With the First Symptom of Neck Pain Misdiagnosed as Acute Stroke

Yi Bao, Xingyue Li, Yajie Hu, Lixia Qin, Miao Zhang, Ying Wang, Guangjian Liu

Abstract


This article aims to describe the clinical features of a demyelinating lesion in the medullary and cervical spinal cord junctions with a first symptom of neck pain misdiagnosed as acute stroke. The patient was initially misdiagnosed as ischemic stroke through stroke-like onset, clinical manifestations, physical examination, and brain computed tomography (CT); but the patient’s symptoms were not completely consistent with typical physical examination of stoke. Combined with brain magnetic resonance imaging (MRI) which showed demyelinating lesions and diagnostic treatment, the final diagnosis was the demyelinating lesion of the medulla oblongata and cervical cord junction. Acute hemiplegia in quiet state is not necessarily a stroke. Detailed physical examination and imaging data are helpful for differential diagnosis. Diagnostic treatment can help to confirm the diagnosis if necessary. Early use of methylprednisolone shock therapy combined with intravenous administration of gamma globulin for demyelinating disease can achieve good results, save limb function; and long-term medication is required to prevent rebound.




J Med Cases. 2019;10(3):89-92
doi: https://doi.org/10.14740/jmc3270

Keywords


Demyelination; Acute stroke; IVIG; Cerebrospinal fluid

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