Montecristo

Neurology Resident

67F admitted after having left sided weakness and aLOC.

CTA did not show LVO. MRI shows cortical ribboning and true restriction on DWI with matching ADC.

Clinically she started having well formed, visual hallucinations.

Can you describe what you see on MRI?

Visual hallucinations, are they explained by the pictures? rationale?

She has no parkinsonism on exam, what would be a consideration if this would be present?

Hint: She received 50mg quetiapine one night for agitation and this worsened her hallucinations the day after.

Diagnosis added by author

CLN: Cortical laminar necrosis.

Suspected LBD (classic symptoms: fluctuation on LOC (resembles stroke), visual (well formed) hallucinations, +/- parkinsonism, +/- sensitivity to neuroleptics, +/- dementia, +/- REM like sleep disorder.

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