The syndrome of acute bilateral basal ganglia lesions presents with parkinsonism, altered mental status, dysarthria, and dysphagia in association with specific imaging findings in the basal ganglia. It is an uncommon syndrome seen almost exclusively in patients with diabetes mellitus and renal failure. Previously reported cases have all run a monophasic course, but we report a patient with a relapsing, remitting course. This 64-year-old diabetic man with uremia on hemodialysis had an acute episode of disordered sensorium. Brain computed tomography showed the classic findings of hypointensity of bilateral basal ganglia. He recovered from the episode, but had another with parkinsonian symptoms about 18 months later. Sequential brain images demonstrated encephalomalacia of the basal ganglia. His condition waxed and waned several times, but he eventually died of unknown causes less than 2 years after the first event. This syndrome, therefore, may not be limited to just one episode.