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Platysma weakness has been acknowledged as a sign of central hemiparesis, particularly when facial paresis is not obvious. A 71 year old man—who had no history of Bell’s palsy or stroke—had an acute onset of right side dominant tetraparesis, decreased superficial sensation below C3 segment, and micturitional disturbance. He also had platysma weakness on the right side (fig 1), though cranial nerves were normal. Magnetic resonance imaging (MRI) scans of the cervical cord disclosed a high signal intensity in the right side dominant central cord at C3-4 segments on T2-weighted image (fig 2), suggestive of the cervical cord infarction. Platysma muscles are innervated by both the facial nucleus and high cervical cord in mammals,1 which are spared in C4 tetraplegic patients2 but involved in this patient with C3 lesion.
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