Radiological clues to a mitochondrial problem

A 52-year-old man was brought to the emergency department by a family member with concern regarding a change in his behaviour. Over the preceding days, he had become vague and lethargic, and at times paranoid. There were no other reported neurological or systemic symptoms at first presentation. He had a history of hearing loss starting in his 20s, and diabetes diagnosed in his 30s but no personal or family history of neurological disease.

He was of slight build. He was initially alert and orientated but slow to answer questions and had a subtle left-sided weakness. Routine bedside observations and blood glucose were normal.

CT scan of the brain showed bilateral temporal lobe low density consistent with vasogenic oedema with associated mass effect and loss of sulcal markings. MR scan of the brain showed extensive T2/FLAIR hyperintense cortical changes and associated swelling predominantly involving the right temporal lobe, extending to involve the occipital…

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