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Spot diagnosis
  1. Bram Rook1,
  2. Barbera van Harten2,
  3. Heleen Lameijer1
  1. 1 Emergency Department, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
  2. 2 Department of Neurology, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
  1. Correspondence to Dr Bram Rook, Medisch Centrum Leeuwarden, Leeuwarden, The Netherlands; bram.rook{at}

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Clinical introduction

A 61-year-old man was referred to our emergency department with unusual behaviour. He presented at work 1 hour too early and according to his colleagues, he appeared unfocussed and neglectful. For the past day, he had experienced fatigue and a mild headache. He was not able to recall any traumatic event and has no chills or fever. On examination, his vital signs were unremarkable. The physical and neurological examination was non-focal, although he was somewhat apathetic and his attention and concentration were diminished. Two lesions on his left middle finger were visible that were slightly sensitive to touch …

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  • Twitter @RookBram

  • Contributors BR identified and managed the case, wrote the main article and approached the patient for informed consent. BvH and HL both supported the writing process. HL guarantees the article.

  • 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; internally peer reviewed.