I am taking care of 14yo who presented to my office with the complaint of tingling and numbness of her right foot, leg, hand, arm and face. She had been at the pool with a friend swimming whtn she began comlaining of the numbness so they decided to go home. They rode home on bicycles with no mishaps or falls. When she got home, she laid on the couch for a few minutes, then her mom got her back up and she was somewhat wobbly with walking. At that point, the mom decided to bring her in. PMH is significant for a head injury in 1993 which resulted in LOC for several hours but no further problems after the concussion resolved. There was no bleed or fracture. There is some significant family history. On examination, the patient was alert with diffuse slowed mentation, severe confusion, aphasia, apraxia and mild hemiparesis of the right side from the forehead to the toes. She had no other physical signs and no fever. She completely failed a mini mental status exam, unable to state even her own name or count. She could follow only simple instructions and could not demonstrate how to use a pen even after she was shown how, nor could she read anything. However, she appeared to be completely alert, although somewhat agitated when she could not answer questions, and she would answer "I don't know" to almost every question we asked. What do ya'll think we should include in the differential? Have you ever seen anything like this? She has been scary to take care of because of the difficulty in following her mental status. (I have a little more history and the results of a few tests but will give them after I get some feedback.) Thanks for the input. Dr. Carol Carol F. Teplis, MD Associates in Pediatrics Elgin and Streamwood, Illinois