PO239 Jerks in a traveller

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Neurologists are often asked to review patients with presumed meningoencephalitis and depending on the clinical presentation, foreign travel and demographics of the patient a variety of infectious causes are considered in the differential diagoses. We present the case of a middle-aged woman who originates from Nigeria and who initially presented in February 2016 with malaise and generalised weakness. Over the next six months she developed worsening ataxia, a disturbed sleep cycle, upper limb myoclonic jerks with myoclonic tremor and intermittent mild pyrexia. In the later stages of her illness she became increasingly encephalopathic and drowsy. Serology for Trypanosoma brucei Gambiense was found to be positive both in the serum and cerebrospinal fluid. She was diagnosed with Human African Trypanosomiasis (second stage) and treated with Nifurtimox and Eflornithine combination therapy. She made a rapid and near-complete recovery including her myoclonus which resolved (videos pre- and post-treatment show the remarkable improvement and are available to display; appropriate consent taken).

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