MRI examination of the brain revealed evidence of hyperintense signal intensity on T1-weighted sequences in the region of the torcula herophilli and the superior sagittal sinus ( Figure 1A). The patient’s ECG, urinalysis, complete blood counts, biochemical, and coagulation profiles were within normal limits. Cranial nerve, motor and sensory systems, coordination, gait, and stance examinations were all within normal limits. No difficulty in naming, reading, or writing was noted. The patient’s speech was effortless, fluent, and appropriate to educational level, and he executed commands correctly and completely. A CNS examination revealed confusion and disorientation to time with impaired immediate and recent memory but intact remote memory. Cardiovascular, chest, and abdominal examinations were within the normal limits. The patient was afebrile, with a blood pressure of 110/70 mmHg, pulse rate of 80 bpm, which was regular and good volume. The patient had no significant medical illness, including diabetes, hypertension, varicose veins, heart disease, nor was he taking any medication. In addition, there was no history of difficulty in speech, double vision, loss of consciousness, hearing of voices, migraine, abnormal taste, or smell. In the hospital, he was unable to recall the sequence of events that happened on the same day and kept asking, “What has happened? Why I have been brought to the hospital?” Information obtained from the patient’s family members indicated that he had no history of similar episode, seizure disorder, fever, vomiting, neck stiffness, giddiness, weakness, numbness, or abnormal sensation in any part of the body. When asked to whom it was he was talking, he was unable to reply satisfactorily. A history revealed that the man had been talking to himself, saying that his son was in Chandigarh and that he had to fetch an apple box for him. He was immediately brought to the emergency department by his colleagues for a medical opinion. and was found to be confused, asking strange questions and responding inappropriately. A 58-year-old man arrived at his office at 9.00 a.m.
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