Neurological Case 61—A 30y woman found fitting on the train
The ambulance paramedics rush into the emergency department with Jane Doe, an unidentified woman who looks to be around 30 years old, who was found convulsing on a railway train. She was alone in a carriage and has no identification on her person and no Medic-Alert bracelet. She was found lying on the fl oor shaking her arms and legs and making grunting noises by the guard. He knew what a seizure was because his daughter has epilepsy, and he phoned an ambulance immediately. However, they were a long way out of the station and it took 25 minutes for the train to return. She continued to convulse for the duration of the train journey and subsequent ambulance ride, despite the crew giving large doses of diazepam, and by the time she reached hospital had been fi tting for over 40 minutes. The emergency registrar attends to examine the patient, and fi nds a young woman, unresponsive, with eyes tightly closed and resisting eye opening. She was moving all four limbs in a bizarre and violent manner, rocking her body from side to side and fl ailing her limbs asynchronously. She did not respond to voice or to painful stimuli. Administration of intravenous diazepam reduced the movements slightly but she continued to shake. After several doses of diazepam, she began to snore and her oxygen saturations dropped and she had to be intubated and transferred to the intensive care unit.