Following metrizamide myelography, this patient transiently developed quadriparesis, complete loss of reflexes, and disappearance of upper motor neuron signs. Unlike previous cases reported by and Buruma and Hekster [ 3 ] , the weakness and areflexia in our patient were generalized. I t is uncertain whether the impairment was mediated at the level of the ventral roots, anterior horn cells, or corticospinal tracts. Damage to any of these structures could lead to a picture resembling "spi- A 52-year-old woman with a twenty-year history of hypertension, diabetes mellitus for two years, and mild chronic renal failure was seen 12 days after developing violent Hinging movements of her right arm. Physical examination showed choreoathetoid movements with frequent flinging movements involving the right arm. H e r right leg showed only occasional choreoathetoid movements. The movements increased under stress, were absent during sleep, and were diminished somewhat by voluntary activity. There was no alteration in reflexes or muscle tone. T h e rest of the neurological examination was within normal limits. Computerized tomographic scan of the head was normal. Sodium valproate was given at a close of 250 mg orally four times a day, and within 12 hours all abnormal movements disappeared. The patient received a total of ten doses of sodium valproate, after which a similar placebo capsule was substituted for 24 hours. Abnormal movements did not reappear.The observed recovery in this case could have been spontaneous, but the abruptness of the response speaks against it. The similarity in response between our patient and the one reported by Lenton et a1 [
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