MRI brain aids in diagnosing an overlooked cause of acute encephalopathy

Abstract

A 38-year-old male with no significant past medical or substance abuse history presented with a five-day history of vomiting and bloody stools following ingestion of undercooked beef. He was admitted to critical care unit with a diagnosis of hemolytic-uremic-syndrome. Despite aggressive antibiotics and dialysis treatment his mental status deteriorated, requiring intubation on seventh day of admission following 3 episodes of generalized-tonic-clonic seizures. Electroencephalogram (EEG) revealed generalized seizures arising focally from posterior head regions. Magnetic-resonance-imaging (MRI) brain showed symmetric posterior rhombencephalitis with bilateral thalamic involvement (figure A-D). Cerebrospinal-fluid (CSF) analysis showed mild pleocytosis (WBCs: 31, PMNs: 98%), elevated protein (133 mg/dL) and glucose (92 mg/dL). The serum albumin dropped from 4.7 g/dL on admission to 2.3 g/dL on day 7 of admission. Neurology was consulted. On initial examination, patient was stuporous without obvious cranial nerve or focal neurologic deficits (Fig. 1A–D ). (A)Hypoxic ischemic encephalopathy(B)Wernicke’s encephalopathy(C)Creutzfeld-Jakob disease(D)Listerial rhombencephalitis Answer on page 361 The author(s) received no financial support for authorship or publication of this manuscript. The authors have no conflict of interest. (1)S. Farooq: reports no disclosures.(2)A. Willcox: reports no disclosures.(3)J. Figueroa: reports no disclosures. (1)S. Farooq: Manuscript write up and literature search.(2)A. Willcox: revision of manuscript and literature search.(3)J. Figueroa: Critical revision of the manuscript for important intellectual content. MRI brain aids in diagnosing an overlooked cause of acute encephalopathyJournal of Clinical NeuroscienceVol. 44PreviewB: Wernicke’s encephalopathy Full-Text PDF