Brainstem syndrome in a man with diabetes receiving haemodialysis

摘要

The MRI brain (Fig. 1B of Images in Neuroscience: Question) showed abnormal signal extending from the medulla to the mid-brain. The area of abnormal signal did not exhibit restricted diffusion on diffusion weighted imaging but did show patchy enhancement following the administration of gadolinium (Fig. 2 of Images in Neuroscience: Question). An examination of the cere-brospinal fluid (CSF) revealed a normal opening pressure, a normal white cell count and protein level. However, CSF protein electro-phoresis demonstrated intrathecal synthesis of immunoglobulin G (IgG). Cytological analysis of the CSF did not reveal any malignant cells. A whole body [18-F] fluorodeoxyglucose-positron emission tomography (FDG-PET) scan did not demonstrate any metabolically active lesions outside the brainstem.