(A) Magnetic resonance image (MRI) of a 57 year old woman admitted with hepatic encephalopathy.  (A) Magnetic resonance image (MRI) of a 57 year old woman admitted with hepatic encephalopathy. History of alcohol consumption of half to a whole bottle of whisky a day. Admission Na+ 113 mmol/l, K+ 2.3 mmol/l, γGT 1067 mmol/l, bilirubin 106 mmol/l, alanine transaminase 133 mmol/l. Treated with intravenous normal saline; Na+ 119 mmol/l at 36 hours and 128 mmol/l after a further 24 hours. Initial improvement, deterioration on 11th hospital day with pseudobulbar palsy and flaccid quadriparesis. (B) MRI of a 61 year old man with symmetrical lesions of EPM involving basal ganglia and thalami; lesion of CPM was also present (MRIs courtesy of Dr Garrett McGann.)‏ R J Martin J Neurol Neurosurg Psychiatry 2004;75:iii22-iii28 ©2004 by BMJ Publishing Group Ltd