ABSTRACT
This chapter presents a case of a 45-year-old man from a group home with moderate learning disability who is brought to the accident and emergency department. He has a fever and has been reported as having had a fit by a young care worker. She does not give him his medication and is uncertain what it is. His pulse is 100 beats per minute and his blood pressure is 140/98 mm Hg. However given that he has no apparent history of epilepsy it would be unusual for this to start at age 45 unless he has some kind of neurodegenerative disorder, for which psychiatrist have no evidence. The history suggests that he was well until he went to a party. The treatment carries its own risks since dropping the blood pressure quickly can cause hypoperfusion that can particularly affect the kidney, brain and heart. If blood pressure rises precipitously then intravenous sodium nitroprusside can be used but under supervised conditions.
