Case presentations

RAPIDLY PROGRESSIVE COGNITIVE DECLINE IN A TRAVELLER

C. P. Gilmore, R. J. Mills, S. Singhal, A. Szabo. Queens Medical Centre Nottingham, Nottingham, UK, Kings Mill Hospital Mansfield, Mansfield, UK

A 66-year-old male presented with rapidly progressive dementia, evolving over several weeks, and gait unsteadiness. For the previous 3 years, he had been a frequent visitor to Ghana where he had spent time living with an indigenous tribe.

Examination revealed gait ataxia and global cognitive impairment with prominent memory deficits. He subsequently developed a fluctuating level of consciousness with a Glasgow Coma Score ranging from 7–14/15. MR imaging of the brain showed diffuse signal change predominantly involving the hemispheric white matter, with less striking changes in the deep grey matter structures and brainstem. CSF examination demonstrated raised protein, normal glucose and a mild lymphocytosis. Serology for Trypanosoma brucei Gambiense was positive, compatible with a diagnosis of trypanosomiasis (“West African sleeping sickness”). He made a good recovery following treatment with eflornithine, associated with a modest improvement in the radiological changes.

Our case is important because (i) there are very few published reports of MRI findings in trypanosomiasis, despite the high incidence of the condition in sub-Saharan Africa, and (ii) it highlights the importance of considering this potentially treatable CNS infection in patients with a relevant travel history.

Email: chris.gilmore@nottingham.ac.uk

CROSSING INTO ORGANIC NEUROPSYCHIATRY?

S. R. Irani, A. N. Sellbach, A. Vincent, R. Gregory. Department of Clinical Neurology, Oxford University, Oxford, UK

We report a 23-year-old male with a 4-month history of headache, generalised body pain and unusual psychosomatic symptoms, such as the inability to match his facial expression to his emotions. He also described weight loss, anorexia and insomnia. Over the last 2 months he developed panic attacks and jerking of the neck, limbs and body which were worse with movement but also present at rest. His parents divorced 1 month prior to …