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A 61 year old female was referred to University Hospital for evaluation due to altered mental status. The patient's symptoms, which had increased over the preceding 12 hours, were characterized as lethargy and decreasing responsiveness. There was no report of fever, chills, recent URI, UTI symptoms, recent nausea or vomiting, diarrhea or headache. Neither were there any reports or evidence of tick or insect bites. Some melena had been noted at the referring facility but this was not corroborated with an FOBT.