{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,2]],"date-time":"2025-08-02T04:30:40Z","timestamp":1754109040124,"version":"3.37.3"},"reference-count":3,"publisher":"BMJ","issue":"7","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Emerg Med J"],"accepted":{"date-parts":[[2018,12,18]]},"published-print":{"date-parts":[[2019,7]]},"abstract":"<jats:sec id=\"s1\"><jats:title>Clinical introduction<\/jats:title><jats:p>An 88-year-old woman presented with acute onset of involuntary limb movements for one\u2009day. Two days prior she had fallen a suffered a left hip contusion but no head trauma. There was no fever or difficulty breathing. Her heart rate was 72 bpm with blood pressure of 109\/68\u2009mm Hg. Physical examination revealed restricted left hip motion due to pain and a sustained twisted posture of the upper extremity without paresis. Glasgow Coma Scale was 15, and there was no evidence of Kernig\u2019s or Brudzinski\u2019s sign. She underwent a hip X-ray and non-contrast CT scan (figures 1 and 2).<\/jats:p><jats:fig id=\"F1\" position=\"float\" orientation=\"portrait\"><jats:label>Figure 1<\/jats:label><jats:caption><jats:p>Anteroposterior X-radiograph of the hip.<\/jats:p><\/jats:caption><jats:graphic xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"emermed-2018-208104f01\" position=\"float\" orientation=\"portrait\"\/><\/jats:fig><jats:fig id=\"F2\" position=\"float\" orientation=\"portrait\"><jats:label>Figure 2<\/jats:label><jats:caption><jats:p>A non-contrast brain CT.<\/jats:p><\/jats:caption><jats:graphic xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"emermed-2018-208104f02\" position=\"float\" orientation=\"portrait\"\/><\/jats:fig><\/jats:sec><jats:sec id=\"s2\"><jats:title>Question<\/jats:title><jats:p>What is the most likely cause of the clinical presentation?<\/jats:p><jats:p><jats:list list-type=\"alpha-upper\"><jats:list-item><jats:p>Acute meningitis<\/jats:p><\/jats:list-item><jats:list-item><jats:p>Cerebral fat embolism<\/jats:p><\/jats:list-item><jats:list-item><jats:p>Haemorrhagic stroke<\/jats:p><\/jats:list-item><jats:list-item><jats:p>Hypertensive encephalopathy<\/jats:p><\/jats:list-item><\/jats:list><\/jats:p><jats:p><jats:italic>For answer see page 2<\/jats:italic><\/jats:p><jats:p><jats:italic>For question see page 1<\/jats:italic><\/jats:p><\/jats:sec>","DOI":"10.1136\/emermed-2018-208104","type":"journal-article","created":{"date-parts":[[2023,4,4]],"date-time":"2023-04-04T07:20:56Z","timestamp":1680592856000},"page":"415-422","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Woman with acute onset involuntary limb movements"],"prefix":"10.1136","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3656-3687","authenticated-orcid":false,"given":"Tsung-Han","family":"Ho","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jiunn-Tay","family":"Lee","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yaw-Don","family":"Hsu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2019,7,18]]},"reference":[{"key":"2024052709090678000_36.7.415.1","doi-asserted-by":"crossref","DOI":"10.1016\/S0140-6736(15)60064-2","article-title":"Cerebral fat embolism after bone fractures","volume":"386","author":"Aman","year":"2015","journal-title":"Lancet"},{"key":"2024052709090678000_36.7.415.2","first-page":"97","article-title":"Contrast-enhanced MR imaging of cerebral fat embolism: case report and review of the literature","volume":"24","author":"Simon","year":"2003","journal-title":"AJNR Am J Neuroradiol"},{"key":"2024052709090678000_36.7.415.3","doi-asserted-by":"crossref","first-page":"1918.e5","DOI":"10.1016\/j.ajem.2016.02.040","article-title":"Hypertensive brainstem encephalopathy mimicking central pontine myelinolysis: a potential pitfall","volume":"34","author":"Ho","year":"2016","journal-title":"Am J Emerg Med"}],"container-title":["Emergency Medicine Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/emermed-2018-208104","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,27]],"date-time":"2024-05-27T16:09:43Z","timestamp":1716826183000},"score":1,"resource":{"primary":{"URL":"https:\/\/emj.bmj.com\/lookup\/doi\/10.1136\/emermed-2018-208104"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,7]]},"references-count":3,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2019,7,18]]},"published-print":{"date-parts":[[2019,7]]}},"alternative-id":["10.1136\/emermed-2018-208104"],"URL":"https:\/\/doi.org\/10.1136\/emermed-2018-208104","relation":{},"ISSN":["1472-0205","1472-0213"],"issn-type":[{"type":"print","value":"1472-0205"},{"type":"electronic","value":"1472-0213"}],"subject":[],"published":{"date-parts":[[2019,7]]}}}