Spinal cord infarction associated with use of phentermine

Abstract

A 33-year-old African American woman was admitted with acute onset weakness involving all her extremities of 1-day duration. She experienced pain in her retrosternal and cervical regions, followed by acute onset of numbness and weakness of all her extremities with alteration in tone of her speech. Except for phentermine intake for obesity for the last 3 months, the rest of her medical history was unremarkable. Her vital signs were stable, but the forced vital capacity (FVC) was 0.6 l, negative inspiratory force (NIF) was -45 cmH20, body mass index (BMI) was 38.5 kg/m . Cranial nerve examination was normal except for hypo phonic voice. She had flaccid quadriplegia, diffuse areflexia and mute plantar response. Sensation was decreased to all modalities from C3 (cervical) down with loss of bladder and rectal sphincter control. She had elevation of her serum glucose (221 mg/dl), hemoglobin A1C (9.3 %). Her total cholesterol was 157 mg/dl with low-density lipoprotein levels 97 mg/dl. Basic lab works including CSF examination were normal. Transthoracic and transesophageal echocardiography were normal. Magnetic resonance imaging (MRI) of the brain and spine with and without contrast including diffusionweighted imaging demonstrated acute infarction extending from lower left medulla to T3 (thoracic) vertebral body level predominantly involving the anterior cord with corresponding T2-weighted hyper intense signal abnormality (Fig. 1). Computed tomography (CT) of the chest, abdomen and pelvis with contrast and conventional angiogram of the brain and spine failed to reveal abnormalities of the aorta, extra cranial and intracranial vasculature.