A 42 year old man presents to an outside ED with the acute onset of facial numbness and dysarthria. His is without significant risk factor for stroke except for borderline hypertension. He is given diagnosis of stroke. A week after the initial symptom he has worsening symptoms with some arm tingling and worsening dysthria. Scan #1 was performed, has a unhomogenous enhancement with contrast. MS, stroke, cystercircosis is considered. He is seen in neurosurgery clinic and a repeat scan is performed scan #2 only 5 weeks after scan #1. LP is performed with elevated protein and no WBC. A week after scan #1 he was worsening symptoms and develops a plegic arm on the right. He is admitted to neurosurgery and biopsy performed. Biopsy showed significant infiltration of macrophages. Demyelination vs chronic stroke. PET negative.
