(Panel A) Biopsy shows cerebellar cortex with dark Purkinje neurons and Purkinje neuron dropout. There is microvacuolation of neuropil and white matter. Features are consistent with ischemic neuronal changes with surrounding edema. Luxol-fast blue/hematoxylin-eosin (Bar = 50 microns). (Panel B) Neurofilament immunohistochemistry highlights collapsed basket cells which emphasize the Purkinje neuron dropout. (Bar = 50 microns).

List of the various products the patient was taking at the time of symptom onset.

Legend for the Figure e-1 image.