Case in Images


Livedo reticularis caused by brain stem infarction: Case report and literature review

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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

doi: 10.5348/100978Z01LX2018CI

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Xu L, Pei H. Livedo reticularis caused by brain stem infarction: Case report and literature review. Int J Case Rep Images 2018;9:100978Z01LX2018.

ABSTRACT


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

SUPPORTING INFORMATION


Author Contributions

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 Submission

The corresponding author is the guarantor of submission.

Source of Support

None

Consent Statement

Written informed consent was obtained from the patient for publication of this case in images.

Data Availability

All relevant data are within the paper and its Supporting Information files.

Conflict of Interest

Authors declare no conflict of interest.

Copyright

© 2018 Lin Xu et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.


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