Case 218

 A seventy one-year-old male was transported to our hospital by ambulance for persistent nausea. He had several diseases of diabetes mellitus, hypertension, cholecystitis, pneumonia and cardiac failure. One month before, he had been admitted for liver abscess in the local hospital. Even after discharge of the hospital, he was given antibiotics from the hospital. He came to our hospital routinely for diabetes mellitus. This morning, he felt severe nausea with strong tinnitus and then, he called an ambulance. Laboratory test revealed creatinine 1.66 mg/dL, CRP 0.03 mg/dL, red blood cells 389 × 10⁴/mm³, Hb 11.5 g/dL.
He underwent brain MRI (Figs 1-3).

What is your diagnosis ?

1.　Cerebellar tonsil infarction

2.　Cerebellar tonsil hemorrhage

3.　Multiple sclerosis

4.　Wernicke syndrome

5.　Drug (metronidazole) induced encephalopathy

answer

2021.1.20