Case 378

Medical History

A 46 years-old female patient, previously healthy, attended the Emergency Department reporting loss of muscular strength in upper limbs, especially on the left and “feeling faint”. She denies use of drugs or medications. Upon admission, she had a blood pressure of 190 x 100 mmHg, with no other changes in physical examination. Afterwards, magnetic resonance imaging (MRI) of the brain was requested (Images 1-4).

After analyzing the case and the imaging exams presented, what is the most likely diagnosis?

Test Question

(CESPE/UNB - 2009) A 24-years old female patient presented visual loss and sensitivity changes in both lower limbs two weeks before the appointment with no previous infections or vaccination. The neurological examination showed significant visual loss in both eyes, moderated weakness and hyperreflexia of the lower limbs, with bilateral positive Babinski’s sign and sensitive levels in T4-T5. She had no control over her fecal and urinary sphincters. 

According to the hypothetical case described, the alternative which contains the most likely diagnostic hypothesis is:

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