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Woman with acute onset involuntary limb movements
  1. Tsung-Han Ho,
  2. Jiunn-Tay Lee,
  3. Yaw-Don Hsu
  1. Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
  1. Correspondence to Dr Yaw-Don Hsu, Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan; hsu12883{at}gmail.com

Abstract

Clinical introduction An 88-year-old woman presented with acute onset of involuntary limb movements for one day. Two days prior she had fallen a suffered a left hip contusion but no head trauma. There was no fever or difficulty breathing. Her heart rate was 72 bpm with blood pressure of 109/68 mm Hg. Physical examination revealed restricted left hip motion due to pain and a sustained twisted posture of the upper extremity without paresis. Glasgow Coma Scale was 15, and there was no evidence of Kernig’s or Brudzinski’s sign. She underwent a hip X-ray and non-contrast CT scan (figures 1 and 2).

Figure 1
Figure 1

Anteroposterior X-radiograph of the hip.

Figure 2
Figure 2

A non-contrast brain CT.

Question What is the most likely cause of the clinical presentation?

  1. Acute meningitis

  2. Cerebral fat embolism

  3. Haemorrhagic stroke

  4. Hypertensive encephalopathy

For answer see page 2

For question see page 1

  • neurology
  • imaging, CT/MRI
  • accidental falls
  • musculo-skeletal, fractures and dislocations

https://doi.org/10.1136/emermed-2018-208104

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    Footnotes

    • Contributors T-HH managed the case and wrote the manuscript. J-TL analysed and reviewed radiological data and contributed to manuscript review. Y-DH is the corresponding author and performed critical revisions.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; internally peer reviewed.