Answer of August 1999

Clinical History:

F/66 History of chronic renal failure admitted for acute confusion. Blood pressure on admission was 170/110 mmHg.

Figure 1 NECT brain
Figure 2 NECT brain

What is your diagnosis?

                                   Figure 1

                                   Figure 2

Diagnosis:

Uraemic and hypertensive encephalopathy

Discussion:

Figure 1 NECT brain shows bilateral symmetrical hypodensities in internal and external capsules, globus pallidus and mainly the subcortical white matter of the occipital lobe.

Figure 2 NECT brain better demonstrates the occipital lobe hypodensities predominantly affecting the subcortical white matter.This patient has both uraemic (basal ganglia changes) and hypertensive (occipital lobe changes) encephalopathy.