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Dr. Matthew T. Bianchi (Neurology): A 57-year-old man was transferred to this hospital because of progressive cognitive decline. He had a history of recurrent malignant melanoma of the right conjunctiva and eyelid that was treated at this hospital. Nine days before admission, a nurse from the melanoma clinic who contacted him by telephone for a preappointment interview noted that he was incoherent and unable to answer her questions. Four days later, at a clinic visit, his physician noted that the patient had difficulty understanding the conversation. Options for treatment of the malignant melanoma, including orbital exenteration, were discussed with the
Differential Diagnosis
Symmetric Leukoencephalopathy
Toxic Leukoencephalopathy
Substance Abuse
Organic Solvents
Hereditary Leukodystrophies in Adulthood
Summary
Dr. Daniel J. Costello's Diagnosis
Pathological Discussion
X-ALD
Discussion of Management
Anatomical Diagnosis
Source Information
From the Neurology Service (D.J.C., F.S.E.), the Department of Radiology (P.E.G.), and the Department of Pathology (P.K.A.), Massachusetts General Hospital; and the Departments of Neurology (D.J.C., F.S.E.), Radiology (P.E.G.), and Pathology (P.K.A.), Harvard Medical School.
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