ABSTRACT
A 28-year-old schoolteacher was brought to hospital by her husband, who described a 5-hour history of acute disorientation, drowsiness and incomprehensible speech. She had been generally unwell over the preceding week, with symptoms of intermittent fevers, chills, headache, nausea and malaise. She was usually fit and well, although she had attended hospital twice in the past 12 months – first for a spontaneous miscarriage 6 months earlier that occurred 18 weeks into the pregnancy and second for an acutely swollen knee that was aspirated in the emergency department 3 months ago. She took no regular medications. She had never smoked and did not drink alcohol. She was originally from Dubai but had lived in the United Kingdom for the past 20 years. She had last travelled to Dubai 10 months earlier to visit family. She had also visited Switzerland and Austria over the preceding month, where she had been trekking through the countryside.
