title: [Acute tetraparesis of cerebral origin].
abstract: BACKGROUND
  Thrombolytic treatment in the early stage of ischemic cerebral attacks requires rapid confirmation of the diagnosis and topographic localization. Unusual clinical features can lead to misdiagnosis with the risk of delaying optimal therapeutic management.
  
  
  METHODS
  We report the cases of two patients who experienced acute tetraparesis without any associated encephalic sign, consistent with the diagnosis of spinal cord injury. Cervical magnetic resonance imaging (MRI) was normal. Conversely, cerebral MRI displayed in both cases bilateral hemispheric infarction. Two ischemic lesions were revealed in the territory of both anterior cerebral arteries in the first patient, while the second patient had a bilateral infarction in the posterior arms of both internal capsules.
  
  
  CONCLUSIONS
  In case of tetraparesis, emergency spinal cord MRI should be performed to rule out neurosurgical etiologies and ischemia. If negative, cerebral MRI should be performed at the same time to look for early cerebral infarction in both hemispheres and determine the indication for thrombolysis.
authors.affiliation: Service de Neurologie, Faculté de Médecine de Marseille, Université de la Méditerranée, AP-HM, Hôpital de la Timone, Marseille. lionel.feuillet@mail.ap-hm.fr
authors.forename: L
authors.initials: L
authors.lastname: Feuillet
authors.forename: L
authors.initials: L
authors.lastname: Milandre
authors.forename: E
authors.initials: E
authors.lastname: Kaphan
authors.forename: A
authors.initials: A
authors.lastname: Ali Cherif
mesh_terms: D000208:Acute Disease; D000368:Aged; D001921:Brain / Q000098:blood supply; D002545:Brain Ischemia / Q000150:complications* / Q000473:pathology; D002560:Cerebrovascular Circulation / Q000502:physiology; D007839:Functional Laterality / Q000502:physiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D010291:Paresis / Q000150:complications* / Q000209:etiology* / Q000503:physiopathology; D013116:Spinal Cord / Q000473:pathology