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March 24, 2020; 94 (12) Resident & Fellow Section

Clinical Reasoning: A young healthy woman with difficult-to-wean acute ventilator dependence

Swathy Chandrashekhar, Eduardo A. De Sousa
First published February 28, 2020, DOI: https://doi.org/10.1212/WNL.0000000000009150
Swathy Chandrashekhar
From the Department of Neurology (S.C.), University of Oklahoma Health Sciences Center; and Neurology (E.A.D.), Mercy Clinic Oklahoma, Oklahoma City.
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Eduardo A. De Sousa
From the Department of Neurology (S.C.), University of Oklahoma Health Sciences Center; and Neurology (E.A.D.), Mercy Clinic Oklahoma, Oklahoma City.
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Clinical Reasoning: A young healthy woman with difficult-to-wean acute ventilator dependence
Swathy Chandrashekhar, Eduardo A. De Sousa
Neurology Mar 2020, 94 (12) e1340-e1343; DOI: 10.1212/WNL.0000000000009150

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    Figure Brain and spine MRI

    (A) Sagittal T1 image from MRI of the brain demonstrates an 18-mm tonsillar ectopia, dorsal cervicomedullary bump, and syringomyelia concerning for Chiari I malformation. (B) Sagittal T2 view from MRI of the cervical spine demonstrates large intrathecal hyperintensity consistent with a syrinx, extending downward from the C2 level. The lower limit was not captured in the image. (C) Sagittal T2 view from MRI of the thoracic spine demonstrates large intrathecal hyperintensity consistent with a syrinx and extending up to the T6 level. (D) Axial T2 view of the cervical spine shows a markedly dilated central canal appearing as a prominent intrathecal hyperintensity, consistent with syringomyelia.

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