Dysphagia and right leg weakness in a renal transplant patient

Dysphagia and right leg weakness in a renal transplant patient

Dysphagia and right leg weakness in a renal transplant patient

A 54-year-old man presented with a one-week history of right
leg weakness, headaches and blurring of vision. Three months
earlier he had experienced isolated dysphagia developing over
four weeks. Magnetic resonance imaging (MRI) of the brain at
the time showed restricted diffusion in the left medulla and left
occipital lobe (Fig. 1a). A diagnosis of ischaemic lateral medullary
syndrome was made and he was discharged with a nasogastric
feeding tube in situ. Past medical history included renal transplantation
13 years earlier for IgA nephropathy, hypertension and atrial
fibrillation. The patient was on mycophenolate mofetil 500 mg
twice daily and prednisolone 5 mg once daily. His renal function
was poor but stable with an estimated glomerular filtration rate
of 16 mL/min/1.73 m2.
On admission he had reduced tone and power and brisk reflexes
in the right lower limb. There was no cranial nerve deficit. Computed
tomography imaging of the brain did not show any changes
Abbreviations: MRI, magnetic resonance imaging; CSF, cerebrospinal fluid;
HTLV-1, human T-lymphotropic virus-1; HIV, human immunodeficiency virus;
AIDS, acquired immune deficiency syndrome; EBV, Epstein–Barr virus; PTLD,
post-transplant lymphoproliferative disorder; HSV, herpes simplex virus; PCR, polymerase
chain reaction; DNA, deoxyribonucleic acid; CNS, central nervous system.
∗ Corresponding author. Tel.: +44 1214242358; fax: +44 1214241309.
E-mail address: [email protected] (M.L. Munang).
from previous imaging three months earlier. He was initially managed
as a suspected case of acute ischaemic stroke.

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