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A 71-year-old woman presented to the emergency department with confusion and multiple alternating stereotyped unilateral jerks involving the arm and ipsilateral face (figure 1A, B; view supplementary video on the journal's website at http://pn.bmj.com). The jerky episodes started 2 weeks before but had increased progressively in frequency and number. During some attacks, there was loss of awareness and subsequent vocalisation. Routine blood tests and cerebrospinal fluid analysis were normal. MR scan of the …
Contributors PMRC contributed to drafting the manuscript and recording the video. JRPS contributed to drafting the manuscript. CAM contributed to the interpretation of neurophysiological studies. JMVP contributed to the revision of the manuscript and final approval.
Competing interests None declared.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed. This paper was reviewed by Sarosh Irani, Oxford, UK.