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A 48 year old woman, status post renal transplantation six years earlier, died after a two week illness characterised by fever, recurrent seizures, and coma. Widespread abnormalities were seen on neuroimaging. A diagnosis of septic encephalopathy was established on postmortem. We describe the magnetic resonance imaging findings of bilateral basal ganglia, thalamic, cerebellar, brainstem, and cerebral abnormalities in this patient, which correlate with the pathophysiology of septic encephalopathy. E ncephalopathy in association with sepsis without evidence of hepatic or renal dysfunction, hypoxaemia, or other identifiable aetiology is referred to as septic encephalopathy (SE) and is often a diagnosis of exclusion. 1A neuroimaging pattern with neuropathology that corresponds with the pathophysiology associated with SE is described. CASE REPORTA 48 year old woman with hypertension and polycystic kidney disease, status post renal transplant six years earlier, was in good health until one week before admission, when she developed symptoms of urinary tract infection. A subsequent urine culture was positive for Escherichia coli. She was treated with ciprofloxacin; however, symptoms of haematuria, and nausea and vomiting developed, and she was admitted to hospital.The patient was afebrile and her heart rate was 108/min, blood pressure 180/100 mm Hg, and respiratory rate 19/min. She was alert, oriented, and cooperative. The lungs were clear on auscultation, with no appreciable heart murmur. There was right lower quadrant tenderness. The rest of the physical examination was unremarkable. On hospital day 2, her temperature was 38.3˚C (101˚F). She had a grand mal seizure of three to five minutes duration with an apnoeic spell of 30-40 seconds. Phenytoin (1 g) was administered intravenously. A computed tomography (CT) scan of the head was negative. Later that day she had a second seizure, and she was intubated and transferred to the intensive care unit. Medications on admission included prednisone, mycophenolate, diltiazem, aciclovir, and hydrochlorothiazide. She was given levofloxacin 500 mg intravenously followed by one dose of 250 mg orally. Cefotaxime and ganciclovir were added on hospital day 4.On neurologic examination on day 2 the patient was lethargic with a non-focal examination. On day 3 she only opened her eyes to voice and pain, and on day 4 she was unresponsive even to deep pain. The extremities were flaccid and pupils were non-reactive. On day 3 she had another seizure followed by two further seizures on day 4. Cerebrospinal fluid analysis on day 3 was unremarkable other than for protein (195 mg/dl). Repeat spinal fluid analysis on day 8 showed 235 white blood cells/mm 3 , 80% granulocytes, and protein 240 mg/dl. Routine culture of the spinal fluid was negative. Polymerase chain reaction (PCR) for cytomegalovirus, herpes simplex virus, and Lyme's disease, and cryptococcal antigen and serological tests for Bartonella were all negative. A renal ultrasound and CT scan of the abdomen were normal. Blood and urine cu...

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cortex (14.2% astrocytes; 4.8% neurons; 325 cells), 6.4% in CA1 (18% astrocytes; 9.6% neurons; 941 cells), 5.7% in caudatum (20% astrocytes; 6.4% neurons; 470 cells), and 5.3% in cerebellum (3.2% astrocytes; 6.0% neurons; 225 cells). Discussion | Greco et al 6 described the presence of inclusions in 11 cases of men with FXTAS aged 67 to 87 years. In our patient, the number of inclusions were in the low range when compared with those cases. In summary, FXTAS is thought to be a disorder of aging in carriers of FMR1 premutation; however, this case documents that FXTAS can occur earlier in adult life, particularly if another disease process is occurring, such as substance abuse, that may exacerbate the pathological process of FXTAS.

A case of meningioma is reported. At the age of 18 years, the patient had undergone insertion of a Torkildsen shunt through a posteroparietal burr hole for obstructive hydrocephalus secondary to a tumor of the pineal region, of which no biopsy had been made. After the hydrocephalus was relieved, he underwent irradiation of the tumor. Thirty years later, he was treated for an intracranial meningioma wrapped around the shunt. The tumor followed the shunt in all of its intracranial course. Microscopy disclosed pieces of the shunt tube within the meningioma. The role of a foreign body and irradiation in the induction of meningiomas is discussed, and a comprehensive review of the literature is presented. (Neurosurgery 29:113-119, 1991)