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Student Education

The perfect crime

BMJ 2004; 328 doi: (Published 01 May 2004) Cite this as: BMJ 2004;328:0405188
  1. Jalil Ahmed, fourth year medical student1,
  2. C M Cheshire, consultant general physician2
  1. 1University of Manchester
  2. 2Manchester Royal Infirmary

A 27 year old woman presented to the emergency department with collapse, left sided weakness and loss of sensation, and amnesia. We got a history of the night's events before admission from her friends. She had no past medical history and was not known to be a recreational drug user.

On a night out to a club, she had consumed half a bottle of wine, two pints of Guinness, and five single measures of spirits. However, she was “not that drunk and quite alert.” After leaving for the toilet alone, she was later found sitting on a chair at the bar with her head on the tabletop. She seemed confused and did not recognise anyone. Her friends became concerned because she was difficult to arouse. They carried her outside and called an ambulance. She then passed out and became unresponsive for several minutes, but had no seizures, no abnormal movements, no incontinence, and did not bite her tongue.

She could not recognise her friends, did not know her own name, date of birth, or occupation. Nor could she remember her parents' names. However, she could recall her sister's name and occupation and a brother who apparently died some years ago in a road crash. She also remembered accepting a glass of orange juice from a stranger called James and going to the toilet, collapsing, and hitting the back of her head. She then remembered that James asked for her mobile phone to call a friend. She thinks she gave this to him. He then asked for credit cards and asked her to go with him. She is not sure if she complied and does not remember how she ended up on a stool by the bar.

On examination she was talking and opening her eyes spontaneously but was confused, disorientated, …

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