ABSTRACT
A man is admitted to accident and emergency after being found semi-conscious in the street. He is unkempt and does not have any information on his person; he appears to be street homeless. In accident and emergency he has a tonic clonic seizure which is self-limiting after 3 minutes. The man is post-ictal for a short time but soon becomes restless, tremulous and sweaty. His speech is rambling, and he complains about the bed sheets being filthy and ‘filled with mites’. He is tachycardic with a blood pressure of 186/114 mmHg. What is the most likely diagnosis?
