ABSTRACT
A 49-year-old man was referred from the local psychiatric unit with a deteriorating Glasgow Coma Scale (GCS). He had been admitted to the unit 4 weeks earlier after neighbours reported that he appeared unkempt and disorientated. Since admission, the psychiatry team noted that the patient had become increasingly dysarthric, dysphagic, polyuric with urinary incontinence and agitated with new visual hallucinations. He complained of cough, weight loss and profound polydipsia. His past history included bipolar affective disorder, for which he took regular aripiprazole, diazepam and sodium valproate. Until several days earlier, he had been on lithium, quetiapine and procyclidine. He lived alone and was previously independent, smoked 12.5 g tobacco daily and did not drink alcohol.
