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Images in Neurology |

Magnetic Resonance Images of Herpes Zoster Myelitis Presenting With Brown-Séquard Syndrome

Ai Hosaka, MD; Kiyotaka Nakamagoe, MD, PhD; Masahiko Watanabe, MD, PhD; Akira Tamaoka, MD, PhD
Arch Neurol. 2010;67(4):506-507. doi:10.1001/archneurol.2010.45.
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A 32-year-old right-handed woman was febrile at 39°C for 3 consecutive days, after which she developed a rash accompanied by blisters on the lips and nasal cavity and an abnormal sensation in the peripheral parts of the right lower extremity. Eight days after the onset of neurological abnormalities, the salient neurological features were diminished sensation to pain and temperature on the right side below the T4 dermatome; diminished sensation to pain, temperature, and touch on the left side of the T3 dermatome; loss of touch sensibility on the left side below the T4 dermatome; and incomplete paresis of the left leg. Based on these neurological findings, she was diagnosed with Brown-Séquard syndrome. Magnetic resonance imaging showed a left-dominant, high-signal lesion (Figure 1, A and B) or a gadolinium-enhanced lesion on the left side (Figure 2, A and B) in the spine, particularly at the first and second thoracic vertebrae.

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Figure 1.

A, A midsagittal T2-weighted image of the spinal cord shows central hyperintense signal changes (arrow) and swelling from the C7 to T2 levels. B, An axial T2-weighted image shows hyperintense signal changes (arrow).

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Figure 2.

A, A midsagittal contrast-enhanced T1-weighted image shows a gadolinium-enhanced lesion (arrow). B, An axial contrast-enhanced T1-weighted image shows an enhanced lesion (arrow).

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