506

This 63-year-old man, a teacher at a cram school, had a history of uncontrolled hypertension without
medication. He was admitted to the emergency department on 112/04/15 at 22:00 due to left limb
weakness.

Based on the patient's statement and medical chart, he previously had full independence in his
activities of daily living and did not require any walking aids. However, on 112/04/15 at 22:00, he
experienced a sudden onset of weakness in his left limbs, accompanied by slurred speech. He was
unable to stand up from a chair due to muscle weakness. Seeking assistance, he came to our emergency
department for evaluation. Vital signs at the emergency department showed a blood pressure of
199/123 mmHg, heart rate of 113 beats per minute, respiratory rate of 20 breaths per minute, and body
temperature of 36.5°C. Neurological examination revealed a Glasgow Coma Scale score of E4V5M6,
left central type facial palsy, dysarthria, and muscle weakness rated as 5/5 in the right upper extremity
and right lower extremity, and 4/4 in the left upper extremity and left lower extremity. A brain CT scan
revealed a hypodense lesion in the right corona radiata and thalamus. The patient did not report any
diplopia, nausea, or vomiting throughout the course of the disease. Based on the impression of acute
ischemic stroke, the patient was admitted for further management.

510-1

This 53-year-old woman was admitted via the outpatient department due to numbness and weakness in
her bilateral lower limbs for the past five months. According to her family, she was previously fully
independent in activities of daily living. She experienced low back pain after choking in 111/4 and was
subsequently brought to the emergency department (ED) of CSMUH, where myocardial infarction was
suspected. However, cardiac catheterization did not reveal any findings. Despite being discharged, her
low back pain did not improve. She returned to the ED of CSMUH, where a spine MRI revealed a
spontaneous T9-11 subdural hematoma (SDH). She underwent removal of the SDH in 111/4. On
111/11/10, she developed paresthesia in the lower abdomen and abdominal distension, leading to
another visit to the ED of CSMUH. An MRI revealed a T3-7 intraspinal arachnoid cyst, which was
subsequently removed in 111/11. Rehabilitation therapy was arranged thereafter.

In 111/11, she experienced worsening paresthesia in the lower abdomen and developed an unsteady
gait. Follow-up MRI revealed a recurrent cyst in the T3-7 region. As a result, she underwent T10-11-
12 posterior decompression and posterior instrumentation with rods and screws on 111/12/22 at
CSMUH. Following the operation, she complained of numbness and weakness in her left lower limb,
as well as bladder and bowel incontinence. Occasionally, she also experienced the same symptoms on
the right side since 112/04. Although she was able to walk, she required a walker. Seeking a second
opinion, she visited the outpatient department of CMUH on 112/04/26. A thoracolumbar spine x-ray
was performed on 4/26, revealing (1) a previous T10-11-12 posterior decompression and posterior
instrumentation with rods and screws, and (2) suspected marginal syndesmophyte and vertebral body
squaring, possibly indicative of ankylosing spondylitis. At CSMUH, a follow-up spine MRI showed a
cystic lesion causing cord compression in the upper thoracic spine. Based on the recommendation of
the neurosurgeon and the impression of an intraspinal arachnoid cyst, she was admitted to our ward for
further evaluation and management.

Hospital visits:

111/4 ED of CSMUH: myocardial infarction suspected, cardiac catheterization: no finding

111/4 ED of CSMUH: T-spine MRI: T9-11 subdural hematoma SDH

s/p surgical removal of SDH in 111/4

112/11/10: ED of CSMUH: T-spine MRI revealed a T3-7 intraspinal arachnoid cyst

s/p surgical removal of the cyst in 111/11

F/U T-spine MRI: a recurrent cyst in the T3-7 region.

s/p T10-11-12 posterior decompression and posterior instrumentation with rods and screws on
111/12/22 at CSMUH.

112/4/26 CMUH: T-L spine X-ray: previous T10-11-12 posterior decompression and posterior
instrumentation with rods and screws, marginal syndesmophyte and vertebral body squaring

F/U T-MRI: a cystic lesion causing cord compression in the upper thoracic spine