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Woman with acute onset involuntary limb movements


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

Anteroposterior X-radiograph of the hip.

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

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