title: Case report: subacute tetraplegia in an immunocompromised patient.
abstract: BACKGROUND
  Clinical reasoning in Neurology is based on general associations which help to deduce the site of the lesion. However, even "golden principles" may occasionally be deceptive. Here, we describe the case of subacute flaccid tetraparesis due to motor cortical lesions. To our knowledge, this is the first report to include an impressive illustration of nearly symmetric motor cortical involvement of encephalitis on brain MRI.
  
  
  METHODS
  A 51 year old immunocompromized man developed a high-grade pure motor flaccid tetraparesis over few days. Based on clinical presentation, critical illness polyneuromyopathy was suspected. However, brain MRI revealed symmetrical hyperintensities strictly limited to the subcortical precentral gyrus. An encephalitis, possibly due to CMV infection, turned out to be the most likely cause.
  
  
  CONCLUSIONS
  While recognition of basic clinical patterns is indispensable in neurological reasoning, awareness of central conditions mimicking peripheral nervous disease may be crucial to detect unsuspected, potentially treatable conditions.
authors.affiliation: Department of Neurology, University of Würzburg, Josef-Schneider-Str. 11, 97080, Würzburg, Germany. zeller_d@ukw.de.
authors.forename: Daniel
authors.identifier: http://orcid.org/0000-0003-3393-5657
authors.initials: D
authors.lastname: Zeller
authors.affiliation: Department of Radiology, University of Würzburg, Josef-Schneider-Str. 11, 97080, Würzburg, Germany.
authors.forename: Anke
authors.initials: A
authors.lastname: Heidemeier
authors.affiliation: Department of Internal Medicine II, University of Würzburg, 97080, Würzburg, Germany.
authors.forename: Götz Ulrich
authors.initials: GU
authors.lastname: Grigoleit
authors.affiliation: Department of Neurology, University of Würzburg, Josef-Schneider-Str. 11, 97080, Würzburg, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Müllges
mesh_terms: D003586:Cytomegalovirus Infections; D004660:Encephalitis / Q000175:diagnosis* / Q000276:immunology*; D006801:Humans; D016867:Immunocompromised Host; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011782:Quadriplegia / Q000276:immunology* / Q000821:virology
keywords: CMV encephalitis; Case report; Motor cortex; Tetraparesis