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The MR images in figure 2 are of bilateral thalamic T2 hyperintensity which also extended caudally into the tegmental tract and right cerebral peduncle, with anterior extension on the right, into the genu of the internal capsule. Old abnormalities were noted in the pons on the second study.

The patient’s blindness was also associated with retinal detachment, visible on the latest MRI, presumably old retinitis/vasculitis. There was a history of intermittent oral and genital ulcerations and positive pathergy inferred, based on skin reactions following acupuncture. No Turkish or Asian ancestry. No other extra nervous system manifestations.

Brainstem and diencephalic focal encephalitis accounts for about half of the neurological complications of this disease. The imaging features highlight the mixed inflammatory/autoimmune/vasculitic and superimposed ischaemic pathology of this unusual disorder.

One can only imagine the distress of coping with no visual cues and diencencephalic amnesia. Fortunately, the patient and MRI appearances improved dramatically with treatment.

The patient continues to be cared for by …

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