Dysphagia and right leg weakness in a renal transplant patient

Abstract

A 54-year-old man presented with a one-week history of right eg weakness, headaches and blurring of vision. Three months arlier he had experienced isolated dysphagia developing over our weeks. Magnetic resonance imaging (MRI) of the brain at he time showed restricted diffusion in the left medulla and left ccipital lobe (Fig. 1a). A diagnosis of ischaemic lateral medullary yndrome was made and he was discharged with a nasogastric eeding tube in situ. Past medical history included renal transplanation 13 years earlier for IgA nephropathy, hypertension and atrial brillation. The patient was on mycophenolate mofetil 500 mg wice daily and prednisolone 5 mg once daily. His renal function as poor but stable with an estimated glomerular filtration rate f 16 mL/min/1.73 m2. On admission he had reduced tone and power and brisk reflexes n the right lower limb. There was no cranial nerve deficit. Comuted tomography imaging of the brain did not show any changes