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A 60-year-old woman with a historyof chronic back pain presented to theemergency department with headache,slurred speech, and altered sensoriumreported by her family. The previousday, she had a lumbar catheter placedfor symptomatic relief of her chronicback pain. The patient complained onlyof headache, but otherwise thought shewas unaffected. The patient's past medi-cal history was remarkable for diabetes,hypertension, peripheral neuropathy,gastritis, supraventricular tachycardia,and chronic back pain. On physical examinationshe was alert, fully orientated,and in no acute distress. Her vital signswere normal. Neurological examinationrevealed subtle word-finding difficultiesand dysarthria. There were no physicalsigns of raised intracranial pressure (ICP). The remainder of her examination was entirely normal. [ABSTRACT FROM AUTHOR]

A 30-year-old intellectually challengedwoman with recent travel historyto Texas presented with intractablenausea and nonprojectile vomiting for 3weeks. She had diffuse abdominal painwith no change in her bowel movements.Her family noted that she hadrecently become more withdrawn. Onpresentation, she was afebrile with anormal abdominal exam. Physical examinationwas remarkable for subtlebilateral end-gaze nystagmus. An extensiveworkup at an outside hospitalover 2 weeks included upper endoscopywith small bowel follow-through,pelvic sonogram, and a head computedtomography (CT), all of which werereportedly unremarkable. No outsidefilms were accessible at the time. At ourfacility, laboratory examination wasobtained that ruled out an infectiousetiology. Abdominal CT showed nogastrointestinal or hepatobiliary abnormalities.Because of reported personalitychanges and nystagmus on physicalexam, magnetic resonance imaging (MRI) of the head was obtained to rule out cerebellar orvestibular pathology. [ABSTRACT FROM AUTHOR]