Abstract
in upper left limb (4/5). She was transferred to Neurosurgery Department to stereotaxic biopsy and five days after had deteoration of conscience level (Glasgow Coma Scale 11, E3 V3 M5), with acute hydrocephaly in CT and emergency surgery for ventriculoperitoneal shunt and in a second time cerebral biopsy. The patient died four days after. Discussion/conclusion: This case-study shows the importance of medicine semiology, which conduce to an immediately diagnosis, avoiding all the complementary exams. It enhance the internist as the manager of any health unity, capable of creating more economical and suitable alternatives. This quick and fatal evolution in a disease of indolent natural history announce the importance of familiar screening and genetic counselling. Many patients in Psychiatric Institutions have organic disease which should be always excluded.
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