Rapidly Progressive Quadriplegia and Encephalopathy.

Area of Science:

• Neurocritical Care
• Neurology
• Pathology

Background:

• A 77-year-old woman presented with rapidly progressive motor weakness and encephalopathy.
• Clinical examination revealed altered consciousness, myoclonus, and orofacial dyskinesias.

Observation:

• Initial imaging was unremarkable; repeat studies showed cauda equina, trigeminal nerve, and pachymeningeal enhancement.
• Cerebrospinal fluid analysis indicated mild pleocytosis and elevated protein.
• Electrodiagnostic testing revealed a rapidly progressive sensory motor axonopathy.

Findings:

• Electroencephalogram showed progression from generalized slowing to periodic lateralized epileptiform discharges.
• A diagnostic biopsy was performed due to critical historical details.
• The patient's condition deteriorated, becoming unresponsive and ultimately fatal.

Implications:

• This case underscores the diagnostic complexity of rare neurological conditions presenting with rapid deterioration.
• It highlights the importance of serial investigations and diagnostic biopsies in neurocritical care.
• The case facilitates discussion on differential diagnoses and pathological findings of a rare neurological entity.