GREAT MIMICRY IN A PATIENT WITH TETRAPARESIS - A CASE-REPORT

The patient is a 63-year-old Chinese man who presented with tetrapares is and urinary incontinence, The initial diagnosis was cord compressio n from cervical spondylosis, The patient relapsed 3 months after cervi cal laminectomy, The transverse myelitis picture, left optic atrophy a nd suggestive brainstem evoked potentials led to treatment of a presum ptive demyelinating process, The presence of vitiligo, however, led to detection of high titers of antinuclear antibodies (ANA) and presence of anti-nonhistone antibodies, The patient was then diagnosed to have a lupus (SLE)-like disease, which has not fully evolved, He was presc ribed pulsed cyclophosphamide and prednisolone with significant gains both neurologically and functionally up to 1 year of follow-up, This r eport highlights the befuddling impact the disease process have on the clinicians in terms of diagnosis, treatment, and prognosis, That it c an occur in men in the seventh decade of life heightens the need for a wareness in our approach to the myelopathic patient. (C) 1995 by the A merican Congress of Rehabilitation Medicine and the American Academy o f Physical Medicine and Rehabilitation