Presentation
Unconsciousness for the past several hours. No medical history of diabetes mellitus or arterial hypertension. He developed acute reversible dysarthria episodes and vomiting a few days previously.
Patient Data
DW images show bilateral symmetrical high signal intensities in centrum semiovale and posterior limb of internal capsule, sparing cortex and basal ganglia.
No abnormal signal intensity on T2WI or FLAIR.
MR findings most consistent with metabolic or toxic encephalopathy.
Non-contrast abdominal CT shows small kidneys with severe parenchymal atrophy and cortical thinning.
There is small cortical renal cyst on right and small calculus in lower calyx on left.
No hydronephrotic dilatation.
Case Discussion
Laboratory examinations revealed elevated blood urea nitrogen at 65.5 mg/dL and creatinine level of 12.0 mg/dL.
The blood sugar level and other laboratory tests were normal.
Given the clinical setting, lab examinations and radiological findings, is most in keeping with uremic encephalopathy.
Uremic encephalopathy is a well-known complication in renal failure patients and is characterized by a brain syndrome with various neurologic symptoms resulting from brain edema.
Typical MR findings include bilateral vasogenic or cytotoxic edema in the cerebral cortex or basal ganglia.
This case shows signs of bilateral cytotoxic edema in the deep cerebral white matter that do not involve the cortex or basal ganglia.
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