A 27-year-old Zambian man presented to the neurology clinic with a 1-month history of mental status changes and a 5-day history of visual and auditory hallucinations, paranoia, and difficulty walking. Notably, a month before presentation, he became increasingly withdrawn and was diagnosed with depression in a psychiatry clinic. His medical history was also significant for an anal fissure with hematochezia and severe anemia (hemoglobin 4 g/dL) 6 months prior. Examination revealed a thin patient responding to auditory and verbal hallucinations who accused the examiner of trying to harm him. He had a spastic tetraparesis with 2/5 power in all limbs, hyperreflexia with clonus, and a palpable bladder and was unable to walk. Sensory examination was unreliable because of the patient's mental state.

一名 27 岁的赞比亚男性因 1 个月的精神状态改变史和 5 天的幻视和幻听、妄想症和行走困难病史就诊于神经内科诊所。值得注意的是，在就诊前一个月，他变得越来越孤僻，并在精神病学诊所被诊断出患有抑郁症。6 个月前，他的病史也因肛裂伴便血和严重贫血（血红蛋白 4 g/dL）而显着。检查显示一名瘦弱的患者对听觉和言语幻觉做出反应，他指责检查员试图伤害他。他有痉挛性四肢轻瘫，四肢有 2/5 力，反射亢进伴阵挛，膀胱可触及，无法行走。由于患者的精神状态，感觉检查不可靠。