Case 9: Pregnant? Who's Pregnant?: Memory Loss in a Young Woman

Constance Smith-Hicks, MD, PhD


May 26, 2005

Localizing the Lesion

Bilateral mesial temporal lobes are the most likely location, given deficits in both the verbal and nonverbal domains ( Table ). Fluid-attenuated inversion recovery (FLAIR) images support this general localization (Figure 3).

Magnetic resonance-fluid-attenuated inversion recovery (July 14) images showing increased signal in the hippocampus bilaterally.

Remaining possible diagnoses include osmotic demyelination, Hashimoto's thyroiditis, nutritional deficiency, alcoholism, and hypoglycemia. The patient's known history of hyperthyroidism makes Hashimoto's thyroiditis unlikely. There is no history to support nutritional deficiency or alcoholism, leaving hypoglycemia and osmotic demyelination as the most likely possibilities. Although no clear evidence has been found for rapid correction of a sodium imbalance in this patient, the literature would support the presence of other yet unknown mechanisms, because a similar pattern of myelinolysis has been seen in cases devoid of a sodium imbalance.


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