Heading Down the Wrong Path

A CLINICAL PROBLEM-SOLVING article by Michael Detsky from University of Toronto, Ontario, Canada.
A 52-year-old woman experienced the sudden onset of bilateral arm tingling and numbness, and noted that the words on her computer screen appeared “mixed up.” Her condition improved during the next 24 hours, but difficulty swallowing and slurred speech developed, and worsened during the next three days until she was unable to speak. The day before presentation, bilateral impairment of the left visual field developed and she became lethargic. Her family sought medical care for her.
A chest x-ray revealed no abnormalities. Blood studies were within normal limits. CT of the brain showed no obvious lesions.
Follow-up cardiovascular examination was normal. Neurologic examination revealed a number of abnormalities that suggested the presence of lesions in the cerebellum and right hemisphere.
MRI of the brain demonstrated multiple hyperintense lesions on T2-weighted and fluid-attenuated inversion recovery images.
The paitient was treated with cyclosporine and thyroxine. Although there was apparent resolution of some lesions, progression of others is evident elsewhere, indicating active disease.
This case reveals the rare condition, facing the challenging cause, the patient's physicians headed down the wrong path before ultimately reaching the correct diagnosis.

「第303回　東京レントゲンカンファレンス」を参照。