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Singapore Med J 2000; Vol 41(1):

Clinics in Diagnostic Imaging (45)
C Y Chan, H S Lam, J R Jinkins

CASE PRESENTATION

A 65-year-old woman was admitted for fever and cough. Investigation showed right lower lobe pneumonia. It was complicated by respiratory failure and syndrome of inappropriate antidiuretric hormone secretion (SIADH). She had a serum sodium level of 123 mmol/L, which was corrected to 137 mmol/L the next day. Her condition stabilised and she remained fully conscious, though ventilator-dependent. One week later, she became confused and lethargic, and then developed progressive weakness of all four limbs, resulting in a flaccid type of paralysis. Computed tomography (CT) of the brain performed at that time and enhanced CT of the brain done one week later were normal. Cerebrospinal fluid analysis and blood biochemistry were unremarkable. Electroencephalography (EEG) showed diffuse theta waves over both hemispheres, compatible with metabolic encephalopathy. Brainstem auditory evoked potential studies showed abnormal slow conduction. What do the magnetic resonance (MR) scans show (Figs 1a - 1b)? What is the diagnosis?

Answer

Department of Diagnostic Radiology
Tuen Mun Hospital
Hong Kong
China

C Y Chan, MBBS, FRCR, Senior Medical Officer

Department of Diagnostic Radiology
Kwong Wah Hospital
Hong Kong
China

H S Lam, FRCR, FHKCR, FHKAM, Consultant

Division of Neuroradiology
Department of Radiology
University of Texas Health Science Centre
San Antonio
Texas, USA

J R Jinkins, MD, FACR, Associate Professor and Director

Correspondence to: Dr C Y Chan