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A 68-year-old woman referred to the emergency department for impaired consciousness and involuntary right-sided movements. She was affected by epilepsy secondary to cerebral palsy, and she presented partial seizures, occasionally followed by secondary generalisation, well controlled by drug treatment. Brain CT scan, performed in the emergency, showed diffuse hypodensity of the left cerebral hemisphere and of the right cerebellar hemisphere (figure 1). Electroencephalography showed continuous epileptic discharges in the left hemisphere (figure 2). Treatment for seizures with intravenous valproic acid was initiated, and the patient progressively recovered consciousness. Neurological examination showed right spastic hemiparesis as a result of cerebral palsy; in particular, clinical signs of cerebellar dysfunction were absent. Routine blood tests were normal except for high level of sodium (158 mmol/L). Cerebrospinal fluid (CSF) examination showed a normal cell count and glucose level and a mild increase in proteins (42 mg/dL). Bacterioscopic CSF examination was negative. The search on serum for antibodies and the …
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