Abstract
A 28-year-old woman presented with a seven day his-tory of insomnia, and changes in mental status. She was agitated, confused with visual hallucinations and com-bative behaviour. On day 4, she developed partial com-plex seizure with impairment of awareness and automa-tisms of lip smacking. During the first 2 weeks, she had become increasingly drowsy and confused, her level of conciousness was severely impaired, with no response to painful stimuli, and orofacial-limb dyskinesias appeared. These symptoms and central hypoventilation led to her being sedated on mechanical ventilation for 4 weeks. On day 31 after admission, a cardiac arrhythmia, character-ized by alternating repeated episodes of tachycardia and bradycardia was observed.The serum did not contain anti-nuclear, double-strand DNA, SS-A or thyroid antibodies. Tumor markers were normal. Lumbar pucture on day 8 after the onset of symptoms showed lymphocytic pleocytosis (22/mm
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