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Tired and Sleepy Woman with Headaches

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Clinical Cases in Neurology

Part of the book series: In Clinical Practice ((ICP))

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Abstract

48-year-old female was admitted with a 3 days history of “being unwell”, tired and having headaches. Eventually she developed confusion and became progressively sleepy (oscillating level of consciousness (GCS between 14 and 11). According to family she had been incontinent over that period. On admission patient was drowsy, confused and pyrexic (38.1 °C). Her responses were incoherent (usually responded by single words or provided yes/no answers). On objective examination left sided hemiparesis was found, with increased reflexes on the left. There was bilateral ataxia visible especially when walking (gait ataxia) and during finger/nose test (dysmetria). There was also dysdiadochokinesia. There was around 350 ml of residuum in her bladder. There were positive plantars bilaterally. Blood tests revealed CRP of 35 with only borderline leukocytosis.

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Further Reading

  • Eran A, Hodes A, Izbudak I. Bilateral temporal lobe disease: looking beyond herpes encephalitis. Insights Imaging. 2016;7:265–74.

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    Article  Google Scholar 

  • McGrath N, Anderson NE, Croxson MC, Powell KF. Herpes simplex encephalitis treated with acyclovir: diagnosis and long term outcome. J Neurol Neurosurg Psychiatry. 1997;63:321–6.

    Article  CAS  Google Scholar 

  • Misulis KE, Head TC. Netter’s concise neurology updated edition. Philadelphia: Elsevier Health Sciences; 2016.

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  • Mumenthaler M, Mattle H. Neurology. Stuttgart: Thieme; 2011.

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  • Ropper A, Samuels M, Klein J. Adams and Victor’s principles of neurology. 10th ed. New York: McGraw Hill Professional; 2014.

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Authors and Affiliations

  1. Department of Neurology, Dumfries and Galloway Royal Infirmary, Dumfries, UK

    Ondrej Dolezal

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  1. Ondrej Dolezal
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Dolezal, O. (2019). Tired and Sleepy Woman with Headaches. In: Clinical Cases in Neurology. In Clinical Practice. Springer, Cham. https://doi.org/10.1007/978-3-030-16628-1_8

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  • DOI: https://doi.org/10.1007/978-3-030-16628-1_8

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-16627-4

  • Online ISBN: 978-3-030-16628-1

  • eBook Packages: MedicineMedicine (R0)

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