QUESTIONS

1. Consider the case of this 44-year-old Maori woman and suggest a diagnosis and treatment.

The patient developed bilateral blindness 20 years ago—details of assessments and diagnosis at that time are no longer available. Over recent years, attacks of unconfirmed “meningitis”, some with fever, have been treated with antibiotics in her isolated East Coast Maori community.

In 2005 she was hospitalised with an illness characterised by brainstem dysfunction and cerebrospinal fluid (CSF) pleocytosis, without identified pathogen. MRI showed normal supratentorial appearances but multiple foci of high signal in the pons, with some mass effect and oedema which demonstrated impaired diffusion on DWI with no T2 shine through (fig 1). Optic nerves were noted to be atrophic.