PMC5396945_01
(A and B) Bilateral lateral rectus palsy.
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She developed bilateral lateral rectus palsy (Figure 1A and B), with normal upgaze and papillary reflexes.
Clinical course of the patient.
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Her clinical course is summarized in Figure 2.
MRI showing thalamic hyperintensities (arrows). T2 weighted image (A); diffusion weighted image (B).. Abbreviation: MRI, magnetic resonance imaging.
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Magnetic resonance imaging (MRI) of the brain showed hyperintensities in bilateral thalami and in the limbic region, suggestive of limbic encephalitis (Figure 3).
Longitudinal myelitis extending caudally upto L1 and rostrally upto pons. T2 weighted image (A); T1 weighted image (B). The white arrows show white matter hyperintensities.
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MRI of the spine showed T2-weighted hyperintense signal intensities in the spinal cord caudally till the L1 level, predominantly involving the anterior horn cells, and rostrally, they extended upto pons, suggestive of longitudinal myelitis (Figure 4).
ECG showing bradycardia, prolonged QT interval and Osborn Wave (arrow).. Abbreviation: ECG, electrocardiography.
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Osborn wave (Figure 5). Other causes of hypothermia such as hypothyroidism and hypoadrenalism were ruled out with normal thyroid function tests and fasting serum cortisol levels.