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Niki Margari and Simon Page

parenchymal mass at the base of the skull eroding the body of the clivus ( Fig. 1 ). A subsequent lumbar puncture demonstrated markedly raised protein in the CSF (9523 g/l) with very low glucose (<1.1 mmol/l) and polymorphs of 2240 (normal 0). Pneumococcal

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Alicia R Jones, Alan McNeil, Christopher Yates, Bala Krishnamurthy and Peter S Hamblin

pituitary stalk on MRI, with no clear diagnosis, the decision was made to perform lumbar puncture for GCT markers (βhCG, αFP), tuberculosis and flow cytometry. This revealed an elevated βhCG level of 11.4 IU/L (reference <10), with an undetectable αFP level

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A León-Suárez, P Roldán-Sarmiento, M A Gómez-Sámano, A Nava-De la Vega, V M Enríquez-Estrada, F J Gómez-Pérez and D Cuevas-Ramos

of presentation. Third, the finding of atypical lymphocytes in the lumbar puncture confirming CNS infiltration, and, fourth, the normalization of pituitary gland and infundibulum’s anatomical and functional characteristics after chemotherapy. On the

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Anne Soejbjerg, Suzan Dyve, Steen Baerentzen, Georg Thorsell, Per L Poulsen, Jens O L Jorgensen and Ulla Kampmann

performed, including blood and urine profile, skeletal X-rays, lumbar puncture, and a bone marrow biopsy. All results were normal and thus, the diagnosis of a solitary sellar plasmacytoma was made. Postoperative MRI of the brain showed no residual tumor

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Sara Lomelino-Pinheiro, Bastos Margarida and Adriana de Sousa Lages

. Lumbar puncture showed no remarkable changes. Initial investigation workup is showed in Table 2 . Table 2 Initial investigation workup. Investigation Result Normal range Calcium (mmol/L) 1.30 2.10–2.55 Phosphorus

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Clarissa Ern Hui Fang, Mohammed Faraz Rafey, Aine Cunningham, Sean F Dinneen and Francis M Finucane

glomerular filtration rate of 26 mL/min 1.73/m 2 . Because of his altered level of consciousness, we performed CT and MRI brain and then lumbar puncture, all of which were normal. We noted an elevated alanine aminotransferase (ALT) level, most likely due to

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Mohd Shazli Draman, Aoife Brennan, Michael Cullen and John Nolan

/l (150–1000). Parietal cell antibodies were positive. Intrinsic factor antibodies were negative. His MRI brain and spine were normal apart from minimal degenerative changes. Lumbar puncture revealed no cells with normal protein and glucose. Cerebrospinal

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Natasha Shrikrishnapalasuriyar, Mirena Noyvirt, Philip Evans, Bethan Gibson, Elin Foden and Atul Kalhan

On day 3 of admission, she became restless, agitated with an altered level of consciousness and clinical features suggestive of global encephalopathy. CT head, lumbar puncture and initial septic screen were unremarkable. Further radiological

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Despoina Manousaki, Cheri Deal, Jean Jacques De Bruycker, Philippe Ovetchkine, Claude Mercier and Nathalie Alos

papillary edema. Investigation The initial blood cell count was normal (leucocytes, 9.92×10 9 /l; platelets, 262×10 9 /l and hemoglobin 145 g/l) and erythrocyte sedimentation rate levels were mildly elevated (36 mm/h). The lumbar puncture showed the

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Jonathan Brown and Luqman Sardar

disease but no focal abnormality or diagnostic epileptiform activity. However her symptoms were still ongoing, and so a lumbar puncture was performed. Cerebrospinal fluid (CSF) showed raised protein at 993 mg/L (with paired serum protein levels being