On transfer to my ward (on day 2 after admission to the emergency department), the patient was stuporous (Glasgow coma scale 8) and showed a left sided hemiplegia. A CT scan on admission was unchanged compared with the previous scan performed 2 months ago. Control CT scans performed on the following days also showed no significant changes. A magnetic resonance imaging scan essentially confirmed the CT scan findings. Cerebrospinal fluid showed a mild pleocytosis (14 cells/mm3) consisting of granulocytes and lymphocytes as well as
a total protein of 82 mg/dl, which was considered to be consistent with a nonspecific meningeal irritation. An EEG showed periodic lateralized epileptiform discharges (PLEDs) over the right hemisphere (Fig. 48.1). A SPECT study showed marked hyperperfusion of the entire right hemisphere.
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