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Previous Volume 357:164-173 July 12, 2007 Number 2 Next

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Presentation of Case

Dr. Kevin N. Sheth (Neurology): A 58-year-old right-handed woman with type 1 diabetes was admitted to the hospital because of a 2-week history of increasing fatigue and word-finding difficulties and a 2-day history of right-arm weakness.

She had been in her usual state of health until 3 years before admission, when an episode of word-finding difficulty occurred, associated with headache and mild right-sided facial weakness. She was admitted to a local hospital, where computed tomography (CT) of the head revealed no abnormalities. Magnetic resonance imaging (MRI) revealed a punctate subcortical lesion in the left parietal white matter; magnetic resonance angiography . . . [Full Text of this Article]

Differential Diagnosis

Demyelinating Diseases

            Multiple Sclerosis

            Other Causes of Demyelination

Infections

            Lyme Disease

            Human Immunodeficiency Virus

Neoplasms

Mitochondrial Encephalomyopathy, Lactic Acidosis, and Strokelike Episodes

Migraine

Cerebral Vasculopathies

            Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy

            Cerebral Vasculitis

            Binswanger's Disease

            Lacunar Infarcts

Summary

Dr. David M. Greer's Diagnosis

Pathological Discussion

Anatomical Diagnosis

Source Information

From the Department of Neurology (D.M.G.), the Diabetes Center (E.C.), the Palliative Care Service (E.L.K.), the Division of Neuroradiology (R.G.G.), and the Division of Neuropathology (E.T.H.-W.), Massachusetts General Hospital; and the Departments of Neurology (D.M.G.), Medicine (E.C., E.L.K.), Radiology (R.G.G.), and Pathology (E.T.H.-W.), Harvard Medical School.

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