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A 43-year-old right-handed paraplegic man was admitted to the hospital because of increasing confusion and aphasia, increasing fatigue, weight loss, and new decubitus ulcers.
The patient had been well until four years earlier, when diplopia, ataxia, dysarthria, and lethargy developed. A lumbar puncture was performed (Table 1). A magnetic resonance imaging (MRI) scan of the brain (Figure 1) showed increased T2-weighted signal intensity in the pons, which extended into the midbrain, cerebellum, and posterior limb of the internal capsules, with swelling of those structures and slight ventricular enlargement; there was minimal enhancement with gadolinium. Corticosteroids
Differential Diagnosis
Clinical Diagnosis
Dr. Michael Ronthal's Diagnosis
Pathological Discussion
Anatomical Diagnosis
References
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