Methotrexate encephalopathy (probable)
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.
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Multiple confluent areas of altered signal intensity are seen in brainstem, thalami, posterior limbs of internal capsule, periventricular and subcortical white matters, with associated edema. Post-contrast enhancement is seen in the periphery of lesions.
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. Patient succumbed within a week, and methotrexate encephalopathy was considered as most likely diagnosis..