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JAMA Neurology Clinical Challenge
September 16, 2019

Progressive Neurological Impairment and an Enhancing Brainstem Lesion in a Middle-aged Man

Author Affiliations
  • 1Division of Neuroinflammation and Glial Biology, Department of Neurology, University of California, San Francisco
  • 2Division of Hematology and Bone Marrow Transplantation, Department of Medicine, University of California, San Francisco
JAMA Neurol. 2019;76(11):1397-1398. doi:10.1001/jamaneurol.2019.3002

A 53-year-old man developed patchy numbness in his right arm. The numbness progressed over 10 months to involve his entire right arm, patches of his left arm, and his distal lower extremities. He also developed right-hand incoordination and imbalance. A magnetic resonance image (MRI) of the brain is shown in Figure 1A. A complete blood cell count with a differential; liver function testing; tests for HIV, rapid plasma reagin, serum aquaporin-4 antibody, and antinuclear antibodies; and levels of sodium, calcium, creatinine, glucose, thyroxine, and vitamin B12 were unremarkable. Examinations of the cerebrospinal fluid had normal results twice, including for white blood cell count with a differential, glucose level, total protein level, IgG index, oligoclonal bands, cultures, and cytology testing.

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