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What is the diagnosis?
A woman in her forties was brought to hospital from the airport after she returned from a five week overseas trip to Japan and China. She had been unwell for 48 hours with fever, headache, and confusion. Examination findings included meningism, stupor, rigidity of all four limbs, generalised hyperreflexia, myoclonus, and an extensor left plantar response. There was a cerebrospinal fluid (CSF) pleocytosis (white cell count 283 × 109/l, 67% lymphocytes, 33% polymorphs). The CSF protein was 0.55 g/l and the glucose was 3.8 mmol/l. T2-weighted MRI (see fig) showed hyperintense signal in the thalamus.
Neil Anderson, New Zealand
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