PMC6921239_01
MRI showing cytotoxic edema (DWI in panel A and ADC in panel B) in the left caudate head and putamen as well as throughout the cerebral cortex; FLAIR hyperintensity is seen in these areas as well (panel C).
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T2 hyperintensity and restricted diffusion affecting bilateral cerebral cortex as well as the left basal ganglia (Fig. 1). The patient's neurological exam remained the same, so
Median nerve N20 somatosensory evoked potentials on day 4 (panel A) and day 13 (panel B) showing bilateral absence of the N20 response (channel 1). Of note, there is a low amplitude, reproducible N20 on day 13 (C4-C3 derivation in panel B). Vertical gain: 0.3 mu V/div., high frequency filter: 10 kHz, low frequency filter: 10 Hz, Number of averaged responses: 500/limb, patient height: 68 in. Montages: Left median stimulation Channel 1 - Cp4 (contralateral sensory cortex) referenced to Cp3 (ipsilateral sensory cortex) Channel 2 - Cp3 (ipsilateral sensory cortex) referenced to E2 (right Erb's) Channel 3 - C5S (C5 - 5th cervical spinous process) referenced to E2 (right Erb's) Channel 4 - E1 (left Erb's) referenced to E2 (right Erb's) Right median stimulation Channel 1 - Cp3 (contralateral sensory cortex) referenced to Cp4 (ipsilateral sensory cortex) Channel 2 - Cp4 (Ipsilateral sensory cortex) referenced to E1 (left Erb's) Channel 3 - C5S (C5 - 5th cervical spinous process) referenced to E1 (left Erb's) Channel 4 - E2 (right Erb's) referenced to E1 (left Erb's).
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SSEPs were performed on day four for prognostication and showed bilateral absence of the median nerve N20 response (Fig. 2). She had a complicated medical course including acute kidney injury with a blood urea nitrogen (BUN) peaking at 113 mmol/L.
Timeline of events during the patient's hospitalization. The patient's mental status improved modestly despite worsening uremia. The patient was discharged to an inpatient hospice facility on day #18.
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Fig. 3 shows a timeline of events plotted against her BUN.