Case in Images
1 Neurology Department, Affiliated Hospital of Qingdao University, China
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Haitao Pei
Neurology Department, Affiliated Hospital of Qingdao University,
China
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Article ID: 100978Z01LX2018
Introduction: With brainstem stroke, symptoms can arise depending on the exact location of the lesion with respect to the long tracts, brainstem connection, and cranial nerve nuclei. Livedo reticularis is very characteristic for Sneddon’s syndrome. It is rarely caused by dysfunction of brain stem as described is this case.
Case Report: A 50-year-old man complained of sudden onset dysarthria, dysphagia. Upon admission, neurological examination revealed unilateral weakness of the upper and lower face in the right side, Horner’s sign in the right side, severe dysphagia, and mild dysarthria, as well as insufficient temperature and pinprick sensation in left side, livedo reticularis in the extremities of the left limbs up to wrist and ankle. Brain MRI scan showed a lesion in the right medulla, which was responsible for the syndrome. Infarction in the right RVM (rostral ventral medulla) caused decreased sympathetic outflow causing livedo reticularis in the left limbs.
Conclusion: In this case, Livedo reticularis in the left limbs was caused by brain stem infarction in the right, it was not Sneddon’s syndrome. This case might add discussion of other possible causes of livedo reticularis and the relevant neuroanatomy, which could explain disturbances of sympathetic nerve activity causing livedo reticularis.
Keywords: Autonomic nervous system, Brain stem stroke, Livedo reticularis, Rostral ventrolatral medulla
Lin Xu - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Haitao Pei - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this case in images.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
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