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A 62-year-old woman was brought by her family to the emergency department after they had not heard from her for 24 hours. On arrival, she was afebrile with normal vital signs. Random plasma glucose was 7.32 mmol/L (normal 3.60 –5.49). She was awake but with no verbal response and was not following commands. She had irregular, non-rhythmic and purposeless generalised bilateral upper and lower limb movements (see video 1). There was no prior history of similar presentations or movements.
Her MR brain scan (figure 1) showed no acute findings such as stroke or basal ganglia abnormalities.
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Contributors DGM had full access to all the data in the study and took responsibility for the integrity of the data and the accuracy of the data analysis. DGM and PES contributed to study conception and design, acquisition of data, analysis and interpretation and critical revision of the manuscript for important intellectual content.
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 reviewed by Christopher Kobylecki, Manchester, UK.
Author note Used open AI (ChatGPT) to help with English grammar editing. The authors declare use of artificial intelligence (GPT-4 OpenAI) to assist with English grammar review in the manuscript.