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A 52-year-old man was brought to the emergency department by a family member with concern regarding a change in his behaviour. Over the preceding days, he had become vague and lethargic, and at times paranoid. There were no other reported neurological or systemic symptoms at first presentation. He had a history of hearing loss starting in his 20s, and diabetes diagnosed in his 30s but no personal or family history of neurological disease.
He was of slight build. He was initially alert and orientated but slow to answer questions and had a subtle left-sided weakness. Routine bedside observations and blood glucose were normal.
CT scan of the brain showed bilateral temporal lobe low density consistent with vasogenic oedema with associated mass effect and loss …
Contributors All of the listed authors were involved in the production of this manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed by Rhys Thomas, Newcastle-upon-Tyne, UK.