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Author: Nathan Dumpleton / Editor: Nick Tilbury / Codes: NeuC16, SLO1, SLO2, SLO3 / Published: 16/01/2025

A 40-year-old lady is brought to the Emergency Department (ED) by ambulance after her neighbours noticed that she was acting oddly. The patient is currently confused and disorientated. She can tell you her name but doesn’t know what has been happening or why she is in the ED.

The patient has a recorded past medical history of anorexia nervosa, anxiety, depression, alcohol and substance misuse and amenorrhoea. She has had two previous admissions under the care of psychiatry for severely restricted eating.

On examination, the patient has signs of severe malnutrition with a recorded weight of 37kg. Her chest is clear. Her pulse is regular at 105 bpm and her abdomen is soft and non-tender. On neurological examination the patient’s gait is ataxic and you note a horizontal nystagmus.