Presentation
Delirium, confusion progressing to coma. Patient got treated for ectopic gestation, with probably high dose methotrexate. Serum B-HCG levels not checked prior to administration, as per records.
Patient Data
Multiple confluent areas of altered signal intensity are seen in the brainstem, thalami, posterior limbs of the internal capsule, periventricular and subcortical white matters, with associated edema. Post-contrast enhancement is seen in the periphery of lesions.
Case Discussion
The patient deteriorated rapidly, almost progressing to coma, when she was referred to tertiary neurological set-up, where further investigations were carried out. CSF study did not reveal any inflammatory pathology. The patient succumbed within a week, and methotrexate encephalopathy was considered as the most likely diagnosis.