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Abstract Details

An Unusual Presentation of Concomitant Cervical Spinal Cord and Cerebellar Acute Ischemic Stroke in a Patient on Weight Loss Medications
Cerebrovascular Disease and Interventional Neurology
P12 - Poster Session 12 (12:00 PM-1:00 PM)
4-009

To report an uncommon presentation of cerebellar and cervical spinal cord acute ischemic stroke in a patient who is on a combination of fluoxetine and diethylpropion for the past 1 month for weight loss.

To present the rare occurrence of concomitant spinal cord and cerebellar infarction which is not previously reported in literature. 

A 34-year-old moderately obese woman with no significant past medical history except for being on weight loss medication for last 1 month presented to the emergency department with dizziness and right sided weakness. Two days prior to presentation, she experienced severe left sided neck pain followed by right upper and lower extremity weakness. Her weight loss medication included fluoxetine 20mg once daily and diethylpropion 50mg bid as an appetite suppressant.

Magnetic resonance imaging of brain demonstrated multiple foci of restriction on DWI sequence with corresponding low signal attenuation on ADC map in the inferiomedial  and posterior aspect of bilateral cerebellar hemispheres. Initial MRI C spine showed focal segmental area of spinal cord swelling and T2WI/STIR hyperintense signal at the level of C4-C5 suggestive of demyelinating lesion, but with ischemic lesions in the brain we added additional DWI/ADC sequences which showed interval restriction confirming ischemic etiology in spinal cord. Urine toxicology, cerebrospinal fluid studies, transesophageal echo cardiogram, hyercoaguable work up and four vessel digital subtraction cerebral angiogram failed to reveal any underlying cause.
Ischemia of the spinal cord is a rare entity with a poor prognosis but if there is a high clinical suspicion then diffusion imaging of the spinal cord allows a better analysis in the acute setting and avoid misdiagnosis.
Authors/Disclosures
Mushtaq H. Qureshi, MD
PRESENTER 		No disclosure on file
Shayan Ul Haque, MD, MBBS No disclosure on file
No disclosure on file
No disclosure on file
No disclosure on file
Paisith Piriyawat, MD (Texas Tech University) Dr. Piriyawat has nothing to disclose.
Alberto Maud, MD (Paul L. Foster School of Medicine Texas Tech UHSC El Paso, Texas) Dr. Maud has nothing to disclose.
Salvador Cruz-Flores, MD, FÂ鶹´«Ã½Ó³»­ (Paul L. Foster School of Medicine Texas Tech University Health Sciences Center) The institution of Dr. Cruz-Flores has received research support from University of Texas System.
No disclosure on file