Abstract
A 37-year-old man noted thermohypoesthesia of his right arm and chest, followed by dysphagia, nausea and unsteady gait. Five days later, neurological examinations revealed left limb ataxia, truncal instability with a tendency to lean to the right, hypalgesia and thermohypoesthesia on the right side of the region between the levels C2 to Th12. MRI on the 14th day disclosed a high intensity lesion on T1- and T2-weighted images and a mixed signal intensity lesion on the T2-weighted image in the left lateral medulla oblongata. Cerebral angiography demonstrated no abnormality. It was inferred that the segmental dissociated sensory disturbance with facial sparing had been caused by partial involvement of the lateral spinothalamic tract which is somatotopically arranged with the fibers from the sacral segments most lateral. There were no risk factors for cerebral bleeding. We consider that the etiology of this hematoma may have been a crytpic vascular malformation.
