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Case Scenario

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Neurology cases
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  CASE SCENARIO  CASE 1. ã A 62-year old man was taken to a local hospital by his family because he seemed agitated. He vomited once and was complaining of a smell of rotten eggs. In the emergency room he had a generalized tonic-clonic seizure. Twenty days before he had experienced some flu-like symptoms and dry cough which lasted several days and was complaining of pain at both temples. During examination he was confused, uncooperative, and mildly febrile. He perseverated in saluting when asked to say goodbye. His speech was paraphasic and he could not understand complex commands. Right toe was extensor.  ã SUMMARY: A 62-year-old man presenting with acute confusional state and focal neurological findings consisting of aphasia and right Babinski’s  sign. Also described are a generalized tonic-clonic seizure and olfactory hallucination (smell of rotten eggs).  DIFFERENTIAL DIAGNOSIS: ã 1. Viral encephalitis ( HSV,EBV, CMV, VZV); ã 2. Brain abscess; ã 3. Tuberculous meningitis; ã 4. Toxoplasmosis; ã 5. Brain tumors; ã 6. Subdural hematoma.
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