The psychopathological examination showed drowsiness, slower formal thought, reduced incitement and mnestic deficiency. The aggression was controlled after starting with antipsychotics (haloperidol 5 mg/day). The electroencephalogram showed a slow activity of 7 Hz.
The symptoms were suggestive of a cognition-involving disorder, while the physical findings suggested a central lesion. A 1.5-T magnetic resonance imaging (MRI) of the brain revealed multiple periventricular hyperintensities in FLAIR, with hypointensities in T1, a sever lesion load in T2/FLAIR images, black holes in T1 and multiple fresh inflammatory foci after gadolinium enhancement (fig. 1a). Subsequently, an MRI of the cervical spine was obtained showing a 16 × 3-mm central lesion between the C4 and C5 vertebral bodies.