Clinical reasoning: A young woman with rapid mental deterioration and leukoencephalopathy: a treatable cause.

Abstract

A 21-year-old woman was admitted due to rapid worsening of mental deterioration, which led to her becoming bedridden for over 3 months. She was born to consanguineous parents and had mild mental retardation and spastic paraparesis that impaired running. She became pregnant 4 months before admission. During the first weeks of pregnancy she developed deep vein thrombosis, which was treated with anticoagulant therapy. A medical abortion using misoprostol and mifepristone was performed. Since this event, mental changes progressed rapidly. She had a brain MRI showing multifocal T2 white matter signal changes (figure, A and B). A diagnosis of psychosis was considered.