Abstract

1.

A 40-year-old man was admitted with acute hepato-renal failure after a paracetamol overdose. Blood pressure was consistently 170/100. He complained of headache and on day 6 developed sudden bilateral visual loss. Brain MRI (Fig. 1) showed increased FLAIR signal in the occipital and parietal lobes. Seizures then developed. After treatment his central vision recovered over 2 weeks, leaving a minor inferior quadrantinopia and residual contralateral parenchymal damage on repeat MRI (Fig. 2).

1. What is the neurological syndrome?

2. What is the treatment priority?

3. Name five settings, or causes.

Andrew Chancellor, Tauranga, New Zealand

2.

A late-middle-aged retired seaman gave a five and a half year history of progressive wasting and weakness. Six years earlier he had noticed distal leg weakness which had progressed rapidly, and six months later he had bilateral foot drop. Three years later he had reported progressive arm weakness. By the time of presentation he was confined