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An Enigmatic Encephalopathy
  1. Bo Norrving
  1. Department of Clinical Neuroscience, Division of Neurology, Lund University Hospital, S-221 85 Lund, Sweden; E-mail: bo.norrving{at}


A careful history and neurological examination are the cornerstones of practical neurology, the basis for establishing the cause of the problem and so for providing treatment. Neurologists have the reputation of being experts in clinical diagnosis, indeed they are usually proud of this. It is therefore frustrating for senior neurologists to seriously fail in establishing a diagnosis, particularly when the patient is your own father who needs your help. This is the story of my father’s enigmatic illness, which a few years ago challenged my diagnostic skills – and subsequently helped modify my practice.

My father, at that time was 88 years old, and lived in a house in central Sweden with a relative (a few years younger) because my mother had developed severe dementia and had moved to a nursing home some years earlier. He was on long-term medication with warfarin after repeated episodes of pulmonary embolism and deep venous

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