A 50-YEAR-OLD woman diagnosed with scleroderma by positive anticentromere antibodies, Raynaud phenomenon, and acral skin changes with a history of interstitial lung disease and hypertension was admitted to the hospital with worsening dyspnea and hemoptysis. The patient had a difficult hospital course with persistent hypertension, prolonged mechanical ventilation requiring sedation, and dialysis for renal failure. Following discontinuation of sedation, she was less responsive. The neurologic examination findings revealed roving eye movements, reactive pupils, spontaneous blink but not to threat, and right-sided gaze preference. There was weak withdrawal to noxious stimuli on the left side but no response on the right side. She was globally aphasic and remained lethargic. Findings from a workup for cause of stroke were negative. Computed tomography of the head revealed brain calcifications that appeared chronic and were thought to be related to systemic sclerosis.
Gusbi O, Bernardini GL. Brain Calcifications in Systemic Sclerosis. Arch Neurol. 2002;59(10):1642–1643. doi:https://doi.org/10.1001/archneur.59.10.1642
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