Lesson of the month
Systemic vasculitis or not? That is the question
Vlassis Kontogiannisa, Marek Havlatb, James S Loweb, Richard J Powella
a Clinical
Immunology Unit, University Hospital, Queens Medical Centre, Nottingham
NG7 2UH, b Department of Pathology, University Hospital,
Queens Medical Centre, Nottingham
Correspondence to: Dr V Kontogiannis.
Accepted for publication 21 May 1999
| The first 150 words of the full text of this article appear below. |
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Case story |
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A 49 year old white man was admitted after an episode of uncontrolled "twitching" of his left arm and hand that lasted 5-10 minutes. He reported difficulty in finding his words for a few days. Past medical history included three unexplained deep vein thromboses, therefore he was receiving long term warfarin. Clinical examination and limited laboratory tests were unremarkable and he was discharged the same day with no follow up.
In the following days he gradually developed weakness of the right side
of his body, headaches, nausea and increasing speech difficulties. He
was readmitted four weeks later, after a sustained episode of
"twitching" of the right arm, which on this occasion was correctly
recognised to be a focal seizure. Systemic features such as malaise,
fever or weight loss were absent and recent foreign travel was denied;
4/5 weakness of the right limbs, an expressive dysphasia and apathy
were noted but no
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