Magnetic resonance imaging of the brain showing diffuse white matter changes. (a) T2-weighted diffuse hyper-intensity involving the midbrain, insula, and basal ganglia bilaterally. (b) Bilateral symmetric reduced diffusion in periventricular white matter as seen on diffusion-weighted imaging (DWI). (c,d) FLAIR extent was graded severe. 

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... attending clinicians considered hypotheses of delirium and/or puerperal psychosis and conducted a comprehensive workup in the inpatient setting. Her lab results, which included a complete blood count, metabolic panel, lipid profile, thyroid function tests, and serum toxicological screen, were all unrevealing. A magnetic resonance imaging (MRI) of the brain (Figure 1) showed diffuse, extensive confluent T2 hyper-intensity of the periventricular deep and subcor- tical white matter. There was sparing of subcortical U- fibres with associated patchy areas of abnormal restricted diffusion/cytotoxic oedema, predominantly along the deep and subcortical white matter. There was also signal abnormality that involved the bilateral caudate heads and lentiform nucleus. To a lesser extent, there was also involvement of the bilateral thalami. Subtle T2 hyper-intensity involving the left insular cor- tex and left amygdala was noted. Based on these find- ings, the diagnosis of delirium due to toxic leukoencephalopathy was strongly suspected. The patient was sent to an inpatient neurology setting for further investigation and ...