New England Journal of Medicine 2014-07-03

Stereochemical aspects in the 4-vinylcyclohexene biotransformation with rat liver microsomes and purified cytochrome P450s: diepoxide formation and hydrolysis.

Casey M Rice, Siddhartha Yadav, Bobby Boyanton, Prajan Subedi, Jeffrey Band

Index: Chem. Res. Toxicol. 16(1) , 56-65, (2003)

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Abstract

A 51-year-old woman was brought to the emergency room after the development of nonsensical speech, including confused word choices and difficulty with naming objects and counting. Her husband noted that she had reported headache, nausea, vomiting, and fatigue the previous day. Foreword In this Journal feature, information about a real patient is presented in stages (boldface type) to an expert clinician, who responds to the information, sharing his or her reasoning with the reader (regular type). The authors' commentary follows. Stage A 51-year-old woman was brought to the emergency department by her husband after the development of nonsensical speech, including confused word choices, difficulty naming objects, and perseveration with counting. Her orientation, comprehension, and speech patterns had fluctuated throughout the morning. Her husband noted that the day before presentation, she had reported headache, nausea, vomiting, and fatigue. No fevers were noted. She had no history of similar symptoms. Response Acute changes in mental status warrant prompt evaluation. The differential diagnosis includes cerebrovascular events (e.g., ischemic stroke and hemorrhagic stroke), trauma, abscess, seizure, vasculitis, drug intoxication, and infectious processes (e.g., meningitis . . .