270 Scientific Programme 22. European Stroke Conference © 2013 S. Karger AG, Basel 6 Interesting and challenging cases Unusual cause of medullary stroke in young J. Roy1 Apollo Gleneagles Hospitals, Kolkata, INDIA1 Introduction: CNS tuberculosis is not uncommon in developing countries. Tubercular spinal arach-noiditis is one form of CNS tuberculosis where vascular occlusion and spinal infarction may occur. We report a rare case of medullary infarction in a case of extensive tubercular spinal arachnoiditis in a young patient. Case report: This 24 years old male presented with radicular pain in legs with para-paresis for 1 month. MRI of Dorsolumabar spine revealed leptomeningeal enhancement with altered signal intensity of lower cord suggesting myeloradicilitis. CSF showed highly raised protein with lymphocytic pleocytosis. CSF PCR for mycobacterium tested positive. He started improving with antitubercular medication and corticosteroids. After a significant recovery,2 months later, he devel-oped acute onset triparesis preceded by severe vertigo and vomiting. MRI brain and upper cervical spine revealed an acute infarct involving cervicomedullary junction on right side. He was treated with Intravenous methylprednisolone for initial 5 days followed by oral prednisolone in addition to antitubercular drugs. He showed gradual recovery over next 2 months and now he has achieved modified Rankin score 2. Discussion: Tubercular spinal arachnoiditis with spinal infarction has been reported earlier but we did not come across any case report of medullary infarction from this dis-ease. Moreover, onset of new infarction after apparent improvement is also unusual. We report this unique case for the rarity of the location of this stroke by a not-so-rare disease in a young patient.
Karger_ESC London_2013
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