Woman with acute onset involuntary limb movements

• Published in: Emergency medicine journal : EMJ Vol. 36; no. 7; pp. 415 - 422
• Main Authors: Ho, Tsung-Han, Lee, Jiunn-Tay, Hsu, Yaw-Don
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.07.2019
• Subjects: Aged, 80 and over; Cytotoxicity; Edema; Embolism, Fat - complications; Embolism, Fat - epidemiology; Embolisms; Emergency medical care; Female; Fractures; Humans; Hypertension; Intracranial Embolism - complications; Intracranial Embolism - epidemiology; Leg - abnormalities; Leg - diagnostic imaging; Leg - physiopathology; Magnetic Resonance Imaging - methods; Movement Disorders - epidemiology; Movement Disorders - etiology; Radiography - methods; Tomography, X-Ray Computed - methods; Womens health; Taiwan; musculo-skeletal, fractures and dislocations; accidental falls; imaging, CT/MRI; neurology
• ISSN: 1472-0205; 1472-0213
• DOI: 10.1136/emermed-2018-208104

Clinical introductionAn 88-year-old woman presented with acute onset of involuntary limb movements for one day. Two days prior she had fallen a suffered a left hip contusion but no head trauma. There was no fever or difficulty breathing. Her heart rate was 72 bpm with blood pressure of 109/68 mm Hg. Physical examination revealed restricted left hip motion due to pain and a sustained twisted posture of the upper extremity without paresis. Glasgow Coma Scale was 15, and there was no evidence of Kernig’s or Brudzinski’s sign. She underwent a hip X-ray and non-contrast CT scan (figures 1 and 2).Figure 1Anteroposterior X-radiograph of the hip.Figure 2A non-contrast brain CT.QuestionWhat is the most likely cause of the clinical presentation?Acute meningitisCerebral fat embolismHaemorrhagic strokeHypertensive encephalopathy For answer see page 2 For question see page 1