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JAMA Neurology Clinical Challenge |

Subacute Imbalance in a Renal Transplant Patient QUIZ

Lawrence S. Honig, MD, PhD1,2,3
[+] Author Affiliations
1Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University Medical Center, New York, New York
2Gertrude H. Sergievsky Center, Columbia University Medical Center, New York, New York
3Department of Neurology, Columbia University Medical Center, New York, New York
JAMA Neurol. 2015;72(11):1367-1368. doi:10.1001/jamaneurol.2015.1904.
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A woman in her 50s presented with a 1-month history of gait unsteadiness and imbalance, suspected to be due to neuropathy, but she then returned to the emergency department with 2 successive transient episodes, each lasting less than 1 hour, of acute dizziness, disorientation, gait dysfunction, and confusion. What is your diagnosis?

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Brain magnetic resonance imaging showing unsuspected mass lesions. A, A T2 fluid-attenuated inversion recovery (FLAIR) sequence illustrating prominent T2 hyperintensity in the right more than the left parietal white matter suggestive of edema, an expansive mass lesion on the right more than the left splenium of the corpus callosum, and an infiltrative mass lesion in the left thalamus extending into the mesencephalon. B, A T1 sequence after administration of gadolinium contrast agent. Ring-enhancing regions are visible in the right parietal lobe and splenium of the corpus callosum, and a more solidly enhancing lesion is seen in the left thalamus as well as some apparent leptomeningeal enhancement.

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