A 38-year-old normotensive, non-diabetic, non-alcoholic male patient presented with altered sensorium and three episodes of generalized tonic clonic seizures in the past 3 days. Patient had undergone a right hemicolectomy and chemotherapy for cecal carcinoma 3 years ago, followed by excision of recurrent ileo-colic mass 2 years ago. Patient had received repeat chemotherapy 4 months ago for peritoneal metastatic disease, which had induced severe vomiting and diarrhea. He was on parenteral nutrition since then. On examination, the patient was obtunded, afebrile, pale, anicteric with stable vitals. He had bilateral decerebrate posture, was unresponsive to verbal commands and opened eyes only to a painful stimulus. Bilateral extensor plantar response and ankle clonus were elicited.
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