Slurred speech and spirochaetes

Blood tests showed anaemia (113 g/L), deranged coagulation profile (platelets 95×10. per L; INR 1?33; and APTT 45 s), and high serum concentrations of alkaline phosphatase (587 IU/L), aspartate aminotransferase (203 IU/L), and alanine aminotransferase (133 IU/L) MRI of the brain was within normal limits. Neuroleptospirosis occurs in about 2% of patients, with aseptic meningitis being the most common neuro logical manifestation.2 Other presentations include myeloradiculopathy, myelopathy, Guillain-Barré syn drome-like presentation, meningoencephalitis, intra cerebral bleeding, cerebellar dysfunction, iridocyclitis, and tremor or rigidity.3 Cerebellar involvement occurs in about 3% of neuroleptospirosis cases.2 Neuroleptospirosis is under diagnosed, especially in an-icteric forms.