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A 64-year-old woman with a history of hypertension and diabetes was admitted to the emergency room with tetraparesis which had slowly progressed over the previous week.
On examination the patient presented a right-sided dominant tetraparesis, no inferior limb deep tendon jerks and upper limb paraesthesia. No sensory loss, cranial nerve impairment, or weakness of the face or tongue was noted on admission. MRI of the medulla was performed with T1 and T2 weighted sequences because of the possibility of cervical compression myelopathy. This MRI showed no medullary abnormalities except for a narrow spinal canal.
Within the next 24 h the patient developed severe dysphagia. Teraparesis progressed to a right-sided …