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A Young Man with a Fatal Encephalopathy
  1. Rustam Al-Shahi1,
  2. Neil J. Scolding2,
  3. Jeanne E. Bell3,
  4. Adam Z. Zeman1,
  5. Charles P. Warlow1
  1. 1Department of Clinical Neurosciences, Western General Hospital, Crewe Road, Edinburgh EH4 2XU;
  2. 2Institute of Clinical Neurosciences, University of Bristol, Frenchay Hospital, Frenchay Park Road, Bristol BS16 1LE;
  3. 3Department of Neuropathology, Western General Hospital, Crewe Road, Edinburgh EH4 2XU




In early 1999, a right-handed manufacturing engineer in his thirties presented to his general practitioner (GP) with a week-long history of diminished sensation and paraesthesiae affecting his left arm and leg. Two months prior to presentation he had contracted a ‘flu-like illness that had left him with persistent fatigue. At presentation, his GP noticed weakness of his left hand and made a presumptive diagnosis of multiple sclerosis. He prescribed a five-day course of oral prednisolone 40 mg daily, which the patient took for only one day, making a transient improvement. The next day he had difficulty making decisions at work and was stopped by the police for speeding in a residential area. Two weeks after the onset of his neurological symptoms, he was admitted to a local hospital with confusion and then transferred to the Neurology department in Edinburgh the following day.

Two years beforehand, in 1997

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