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How good at neurology are you?

Consultant Neurologist, Tauranga Hospital, New Zealand. E-mail: andrew.chancellor{at}bopdhb.govt.nz

EXTRACT

1. Read the case history and suggest a diagnostic test and result.

A 48-year-old butcher suffered three epileptic seizures within a few weeks, followed by a 2-month history of irritability, agitation and aggressive behaviour – leading to psychiatric assessment. Soon thereafter, executive cognitive disturbances and anterograde verbal memory difficulties with a mild right hemiparesis developed, without fever, headache or signs of raised intracranial pressure. There were no stroke like events. General medical examination, routine laboratory investigations, ESR, auto antibodies and HIV negative. Chest Xray and CT abdomen normal. Figures a and b shows two slices of the MR FLAIR sequence. The CSF was acellular, protein 0.73 g/L, PCR negative for JC and herpes viruses. There was minimal enhancement of the right parietal and left fronto-parietal lesions. The neuroradiological opinion was of an inflammatory, rather than neoplastic disorder. A diagnostic test was performed.

2. Where is the lesion causing this appearance?

See ...

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