PMC10435288_01
Timeline of presentation and outcome in this case. FOUR Score: Full Outline of UnResponsiveness (FOUR) score of 1 (E0M0B0R1); E, eye response; M, motor response; B, brainstem reflexes; R, respiration pattern.
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fig1
Continuous electroencephalogram (cEEG) showed background suppression ratio of 85% which improved to 10% overnight (Figure 1).
Magnetic resonance imaging of brain and cervical cord. (A) Fluid-attenuated inversion recovery (FLAIR) abnormalities in medulla oblongata (red arrows) and ventral aspect of C3-C4 cervical cord (red arrowheads) on hospital day 5. (B) Diffusion restriction in dorsolateral medulla (white arrowheads) and bilateral cerebellar hemispheres (white arrows) on hospital day 5. (C) Improvement in the FLAIR signal in the medulla oblongata (red arrow) and resolution of FLAIR abnormality in cervical cord on hospital day 42. (D) Remnant T2 signal abnormalities in the regions bilateral nucleus tracti solitarii on hospital day 42.
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fig2
Punctate hyperintensities were apparent in the left ventral spinal cord at C3-C4 on fluid-attenuated inversion recovery (FLAIR) sequences indicating subacute infarct (Figures 2A,B). On hospital day 42 repeat MRI revealed persistent FLAIR abnormalities in the dorsolateral medulla, caudal pons and cerebellar hemispheres, and resolution of FLAIR abnormalities in the hippocampi, juxtacortical white matters and upper cervical cord (Figures 2C,D).