Autonomic dysreflexia is a clinical emergency syndrome of uncontrolled sympathetic output that can occur in patients who have a history of spinal cord injury. Despite its frequency in spinal cord injury patients, central nervous system complications are very rare. We report a man with traumatic high level incomplete spinal cord injury who suffered hypertensive right thalamic hemorrhage secondary to an episode of autonomic dysreflexia. Prompt recognition and removal of the triggering factor, the suprapubic catheter obstruction which led to hypertensive attack, the patient had a favorable functional outcome after the resorption of the hematoma and effective rehabilitation programme.
Here, we report a case who had idiopathic localized lipoatrophy and want to emphasize the role of magnetic resonance imaging (MRI) in the evaluation of atrophic lesions. Informed consent was taken from the patient. A 48-year-old female who was a physical education teacher was admitted to our clinic with a 16-year history of slowly progressive atrophy on her anterolateral part of right tight. She described a tingling-like sensation on the atrophic area at the beginning. She also realized a slight atrophy on her left tight in addition to the sensation for the last one year. She did not have an occult trauma or injection history to this atrophic area. Her physical examination revealed only an artophic area on her right tight without any skin coloration pathology. There was no muscle weakness and sensory deficit. Her electromyography (EMG) test was also normal both in upper and lower extremities. Lumbar MRI did not reveal any pathology. Lower extremity MRI (Figure 1 and 2) showed localized atrophy in only adipose tissue on the anterolateral part of her right tight. There was no muscle pathology in the neighborhood of the atrophy. Her blood tests including complete blood count, thyroid functions, infection markers and vasculitic screen were all normal. Localized lipoatrophy usually presents as isolated or multiple, atrophic, depressed areas which are commonly found in the proximal part of extremities. We report a case with idiopathic localized lipoatrophy and want to emphasize the role of magnetic resonance imaging in the evaluation of atrophic lesions.
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