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Case Records of the Massachusetts General Hospital
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Volume 350:1882-1893 April 29, 2004 Number 18
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Case 14-2004 — A 66-Year-Old Man with Progressive Neurologic Deficits
Igor J. Koralnik, M.D., Dawid Schellingerhout, M.D., and Matthew P. Frosch, M.D., Ph.D.

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Presentation of Case

A 66-year-old, right-handed man was admitted to the hospital because of progressive left-sided weakness.

Nineteen years before admission, the patient had received a renal transplant from a living related donor because of end-stage renal failure due to nephrolithiasis. He had alcoholic cirrhosis, which resulted in variceal bleeding and recurrent ascites requiring intermittent paracentesis. Other problems included type 1 diabetes mellitus, cholelithiasis, osteoarthritis (for which bilateral hip replacements had been performed), and coronary artery disease.

Two months before admission, weakness of the left side of the face and left hand developed. A cranial magnetic resonance imaging (MRI) study (Figure 1. . . [Full Text of this Article]

Differential Diagnosis

Causes of Leukoencephalopathy

            Vascular Causes

            Toxic and Metabolic Causes

            Hereditary Causes

            Autoimmune and Inflammatory Causes

            Tumoral Causes

            Infectious Causes

Progressive Multifocal Leukoencephalopathy

Clinical Diagnosis

Dr. Igor J. Koralnik's Diagnosis

Pathological Discussion

Anatomical Diagnosis


Source Information

From the Departments of Neurology and Medicine, Beth Israel Deaconess Medical Center (I.J.K.); the Departments of Radiology (D.S.) and Pathology (M.P.F.), Massachusetts General Hospital; and the Departments of Neurology (I.J.K.), Radiology (D.S.), and Pathology (M.P.F.), Harvard Medical School — all in Boston.


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