1. A 21 year old woman with frequent vomiting
Teaching NeuroImages
Neurology
Resident and Fellow Section
© 2014 American Academy of Neurology

2. Presentation
2 week history frequent vomiting and a sudden loss of consciousness.
slurred speech and dysphagia
Chen et al.
© 2014 American Academy of Neurology

3. Imaging Chen et al. A B C Figure 1: Brain MRI
Figure 1A and 1B: T2-weighted axial and sagittal MRI revealed focal hyperintense lesions within the medulla oblongata.
Figure 1C: FLARE coronal MRI showed hyperintense white matter lesions predominantly involving medulla oblongata.
Chen et al.
© 2014 American Academy of Neurology

4. Imaging Chen et al. B A Figure 2: Histopathology images● ▲ ■
Figure 2: Histopathology images
Figure 2A:HE staining of salivary gland showed acinar atrophy (■), small duct dilatation (●) and focal lymphocytic infiltration (▲). (×100).
Figure 2B:Presence of lymphocytic (white arrow) and plasma cells (yellow arrow) is shown at a higher magnification (×200).
Chen et al.
© 2014 American Academy of Neurology

5. “Primary Sjögren syndrome presenting as isolated lesion of medulla oblongata”
Primary Sjögren syndrome(pSS) is characterized by chronic inflammation of exocrine glands such as lachrymal and salivary glands.
pSS should be taken into account in patients with non-specific neurological symptoms. Neurological onset may preexist the appearance of systemic symptoms by many years.
References
Garcia-Carrasco M，Ramos-Casals M，Rosas J，et al. Primary Sjogren syndrome: clinical and immunologic disease patterns in a cohort of 400 patients. Medicine (Baltimore) 2002;81:
(2)Gono T， Kawaguchi Y， Katsumata Y， et al. Clinical manifestations of neurological involvement in primary Sjögren’s syndrome. Clin Rheumatol. 2011;30:
Chen et al.
© 2014 American Academy of Neurology