A reversible cause of longitudinally extensive transverse myelopathy: question

Abstract

A 27-year-old man presented with a 5 day history of progressive headache with nausea, vomiting, blurred vision, weakness in the lower limbs and urinary incontinence. His past medical and familial histories were unremarkable. An examination revealed blood pressure of 230/140 mmHg, bilateral hypertensive retinopathy with papilledema, and mild paraparesis with brisk tendon reflexes. His blood tests revealed elevated creatinine (3.4 mg/dL) and urea (145 mg/dL) levels. The MRI scan of the brain and spine showed a longitudinally extensive signal change from the brainstem down to the mid-thoracic spine level, without contrast enhancement (Fig. 1). The tests for serum anti-aquaporin-4 immunoglobulin G antibodies, viral serologies and rheumatology, were negative. The cerebrospinal fluid examination was normal, with a negative polymerase chain reaction for herpes simplex virus (HSV-1 and HSV-2). He was commenced on parenteral and oral antihypertensive therapy, and a complete neurological improvement was observed after 4 days. The neuroimaging studies