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Meningitis can present as a stroke mimic. We report a case of a 69 years old lady who presented to accident and emergency 2-hours after an episode of vomiting followed by sudden onset left sided weakness and drowsiness. Examination revealed left sided weakness with dysphasia. Initial plan was to decide if the patient was for thrombolysis. An urgent CT scan ruled out hemorrhage. On re-examination the patient was febrile and there was some degree of neck stiffness. Magnetic resonance imaging of brain was performed (DW1 no stroke) which ruled out acute ischemia. A lumber puncture was done eventually that showed low glucose, high leukocyte count, and gram staining revealed diplococci in chains. Clinicians should bear in mind the differential diagnosis of meningitis when there are risk factors and overlapping clinical symptoms. [ABSTRACT FROM AUTHOR]

Moyamoya disease is a chronic cerebrovascular disease, more common in Japanese and Asian population. It is rare in European and American population. The typical presentation is seizure, Transient Ischemic Attack or Stroke and diagnosed radiologically with typical angiographic appearance of the vascular collateral network. We are reporting this unusual case of Moyamoya Disease in a Caucasian adult who presented to A&E with an episode of tonic colonic seizure. In past she had Recurrent Transient Ischemic Attacks so as a part of workup for stroke and seizure, all relevant workup was done. Carotid doppler showed an increase in end-diastolic flow velocity and a decrease in vascular resistance in both external carotid arteries. Subsequently, MRI Brain and MRA showed a rare Moyamoya disease. This disease should be considered an important differential in patients presenting with recurrent seizure episodes or neurological symptoms. [ABSTRACT FROM AUTHOR]