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T1 Age 2 13 35-year-old T2 Sex 14 19 woman T3 Duration 40 45 5-day E1 Duration:T3 T4 Clinical_event 24 32 admitted E2 Clinical_event:T4 T5 Sign_symptom 68 78 drowsiness E3 Sign_symptom:T5 A1 TREND E3 INC T6 Sign_symptom 80 87 fatigue E4 Sign_symptom:T6 A2 TREND E4 INC T7 Sign_symptom 89 108 personality changes E5 Sign_symptom:T7 A3 TREND E5 INC T8 Sign_symptom 122 130 weakness E6 Sign_symptom:T8 A4 TREND E6 INC T9 Detailed_description 110 121 generalised R1 MODIFY Arg1:T9 Arg2:E6 T10 Diagnostic_procedure 149 157 mobility E7 Diagnostic_procedure:T10 T11 Qualitative_concept 135 148 deteriorating R2 MODIFY Arg1:T11 Arg2:E7 T12 History 190 234 10-year history of schizo-affective disorder T13 History 236 270 lithium-induced diabetes insipidus T14 History 275 289 hypothyroidism T15 Duration 190 197 10-year E8 Duration:T15 T16 Disease_disorder 209 234 schizo-affective disorder E9 Disease_disorder:T16 T17 Disease_disorder 252 270 diabetes insipidus E10 Disease_disorder:T17 T18 Detailed_description 236 251 lithium-induced R3 MODIFY Arg1:T18 Arg2:E10 T19 Disease_disorder 275 289 hypothyroidism E11 Disease_disorder:T19 T20 Medication 316 332 sodium valproate E12 Medication:T20 T21 Dosage 333 348 1 g twice daily R4 MODIFY Arg1:T21 Arg2:E12 T22 Medication 350 363 carbamazepine E13 Medication:T22 T23 Medication 365 375 quetiapine E14 Medication:T23 T24 Medication 380 387 lithium E15 Medication:T24 T25 Sign_symptom 419 425 drowsy E16 Sign_symptom:T25 T26 Sign_symptom 427 445 difficult to rouse E17 Sign_symptom:T26 T27 Activity 447 455 sleeping E18 Activity:T27 T28 Detailed_description 456 486 all night and in the afternoon R5 MODIFY Arg1:T28 Arg2:E18 T29 Activity 392 401 admission E19 Activity:T29 T30 Diagnostic_procedure 493 511 Glasgow Coma Scale E20 Diagnostic_procedure:T30 T31 Diagnostic_procedure 513 516 GCS E21 Diagnostic_procedure:T31 R6 IDENTICAL Arg1:E21 Arg2:E20 T32 Quantitative_concept 522 527 14/15 R7 MODIFY Arg1:T32 Arg2:E20 T33 Diagnostic_procedure 545 567 mini-mental test score E22 Diagnostic_procedure:T33 T34 Quantitative_concept 572 576 6/10 R8 MODIFY Arg1:T34 Arg2:E22 T35 Qualitative_concept 601 605 slow R9 MODIFY Arg1:T35 Arg2:E22 T36 Diagnostic_procedure 624 648 Neurological examination E23 Diagnostic_procedure:T36 T37 Diagnostic_procedure 835 847 examinations E24 Diagnostic_procedure:T37 T38 Biological_structure 818 834 gastrointestinal T39 Biological_structure 802 813 respiratory T40 Biological_structure 786 800 Cardiovascular R10 MODIFY Arg1:T38 Arg2:E24 R11 MODIFY Arg1:T39 Arg2:E24 R12 MODIFY Arg1:T40 Arg2:E24 T42 Disease_disorder 909 924 hepatic disease E25 Disease_disorder:T42 A5 POLARITY E25 NEG T43 Diagnostic_procedure 934 946 biochemistry E26 Diagnostic_procedure:T43 T44 Qualitative_concept 951 963 unremarkable R14 MODIFY Arg1:T44 Arg2:E26 T45 Detailed_description 926 933 Routine R15 MODIFY Arg1:T45 Arg2:E26 T46 Diagnostic_procedure 1147 1150 B12 E27 Diagnostic_procedure:T46 T47 Diagnostic_procedure 1155 1161 folate E28 Diagnostic_procedure:T47 T48 Detailed_description 1141 1146 serum R16 MODIFY Arg1:T48 Arg2:E27 R17 MODIFY Arg1:T48 Arg2:E28 T49 Qualitative_concept 1134 1140 normal R18 MODIFY Arg1:T49 Arg2:E27 R19 MODIFY Arg1:T49 Arg2:E28 T50 Diagnostic_procedure 979 999 alanine transaminase E29 Diagnostic_procedure:T50 T51 Lab_value 1004 1009 7 u/L R20 MODIFY Arg1:T51 Arg2:E29 T52 Diagnostic_procedure 1018 1038 alkaline phosphatase E30 Diagnostic_procedure:T52 T53 Lab_value 1039 1045 61 u/L R21 MODIFY Arg1:T53 Arg2:E30 T54 Diagnostic_procedure 1056 1078 γ-glutamyl transferase E31 Diagnostic_procedure:T54 T55 Lab_value 1079 1085 17 u/L R22 MODIFY Arg1:T55 Arg2:E31 T56 Diagnostic_procedure 1096 1105 bilirubin E32 Diagnostic_procedure:T56 T57 Lab_value 1110 1118 6 μmol/L R23 MODIFY Arg1:T57 Arg2:E32 T58 Diagnostic_procedure 1211 1218 lithium E33 Diagnostic_procedure:T58 T59 Qualitative_concept 1231 1259 within the therapeutic range R24 MODIFY Arg1:T59 Arg2:E33 T60 Detailed_description 1205 1210 Serum R25 MODIFY Arg1:T60 Arg2:E33 T61 Diagnostic_procedure 1181 1203 thyroid function tests E34 Diagnostic_procedure:T61 T62 Qualitative_concept 1174 1180 normal R26 MODIFY Arg1:T62 Arg2:E34 T63 Diagnostic_procedure 1271 1278 ammonia E35 Diagnostic_procedure:T63 T64 Diagnostic_procedure 664 669 power E36 Diagnostic_procedure:T64 T65 Qualitative_concept 656 663 reduced R27 MODIFY Arg1:T65 Arg2:E36 T66 Biological_structure 677 688 lower limbs R28 MODIFY Arg1:T66 Arg2:E36 T67 Quantitative_concept 690 695 3–4/5 R29 MODIFY Arg1:T67 Arg2:E36 T68 Qualitative_concept 702 724 pyramidal distribution R30 MODIFY Arg1:T68 Arg2:E36 T69 Diagnostic_procedure 736 744 reflexes E37 Diagnostic_procedure:T69 T70 Diagnostic_procedure 757 766 sensation E38 Diagnostic_procedure:T70 T71 Qualitative_concept 730 735 brisk R31 MODIFY Arg1:T71 Arg2:E37 T72 Qualitative_concept 750 756 intact R32 MODIFY Arg1:T72 Arg2:E38 T73 Detailed_description 770 784 all modalities R33 MODIFY Arg1:T73 Arg2:E38 R34 SUB_PROCEDURE Arg1:E36 Arg2:E23 R35 SUB_PROCEDURE Arg1:E37 Arg2:E23 R36 SUB_PROCEDURE Arg1:E38 Arg2:E23 T74 Lab_value 1283 1292 47 μmol/L R37 MODIFY Arg1:T74 Arg2:E35 T75 Diagnostic_procedure 1309 1318 valproate E39 Diagnostic_procedure:T75 T76 Qualitative_concept 1339 1347 elevated R38 MODIFY Arg1:T76 Arg2:E39 T77 Lab_value 1348 1356 140 mg/L R39 MODIFY Arg1:T77 Arg2:E39 T78 Disease_disorder 1708 1720 encephalitis E40 Disease_disorder:T78 A6 POLARITY E40 NEG T79 Disease_disorder 1722 1745 Guillain-Barré syndrome E41 Disease_disorder:T79 A7 POLARITY E41 NEG T80 Disease_disorder 1750 1786 acute disseminated encephalomyelitis E42 Disease_disorder:T80 A8 POLARITY E42 NEG T81 Disease_disorder 1788 1792 ADEM E43 Disease_disorder:T81 R40 IDENTICAL Arg1:E43 Arg2:E42 T82 Disease_disorder 1910 1950 valproate hyperammonaemic encephalopathy E44 Disease_disorder:T82 T83 Disease_disorder 1952 1955 VHE E45 Disease_disorder:T83 R41 IDENTICAL Arg1:E45 Arg2:E44 T84 Diagnostic_procedure 1565 1568 EEG E46 Diagnostic_procedure:T84 T85 Diagnostic_procedure 1453 1468 Lumbar puncture E47 Diagnostic_procedure:T85 T86 Qualitative_concept 1482 1487 clear T87 Biological_structure 1488 1507 cerebrospinal fluid R42 MODIFY Arg1:T87 Arg2:T86 R43 MODIFY Arg1:T86 Arg2:E47 T88 Diagnostic_procedure 1509 1525 white cell count E48 Diagnostic_procedure:T88 T89 Diagnostic_procedure 1536 1543 protein E49 Diagnostic_procedure:T89 T90 Quantitative_concept 1526 1534 <1×106/L T91 Lab_value 1544 1552 0.25 g/L R44 MODIFY Arg1:T91 Arg2:E49 R45 MODIFY Arg1:T90 Arg2:E48 R46 SUB_PROCEDURE Arg1:E48 Arg2:E47 R47 SUB_PROCEDURE Arg1:E49 Arg2:E47 T92 Diagnostic_procedure 1865 1874 valproate E50 Diagnostic_procedure:T92 T93 Diagnostic_procedure 1879 1886 ammonia E51 Diagnostic_procedure:T93 T94 Lab_value 1858 1864 raised E52 Lab_value:T94 R48 MODIFY Arg1:E52 Arg2:E50 R49 MODIFY Arg1:E52 Arg2:E51 T95 Medication 1992 2008 sodium valproate E53 Medication:T95 T96 Dosage 2013 2028 reduced by half R50 MODIFY Arg1:T96 Arg2:E53 T97 Disease_disorder 2146 2171 schizo-affective disorder E54 Disease_disorder:T97 T98 Lab_value 2215 2226 improvement E55 Lab_value:T98 T99 Diagnostic_procedure 2234 2247 mental status E56 Diagnostic_procedure:T99 R51 MODIFY Arg1:E55 Arg2:E56 T100 Date 2173 2186 Within 3 days E57 Date:T100 T101 Activity 2273 2276 sit E58 Activity:T101 T102 Activity 2281 2292 communicate E59 Activity:T102 T103 Diagnostic_procedure 2316 2345 abbreviated mental test score E60 Diagnostic_procedure:T103 T104 Lab_value 2346 2354 improved E61 Lab_value:T104 T105 Lab_value 2358 2363 10/10 E62 Lab_value:T105 R52 MODIFY Arg1:E61 Arg2:E60 R53 MODIFY Arg1:E62 Arg2:E60 T106 Date 2450 2462 After 4 days E63 Date:T106 T107 Clinical_event 2471 2481 discharged E64 Clinical_event:T107 T108 Nonbiological_location 2482 2486 home R54 MODIFY Arg1:T108 Arg2:E64 T109 Sign_symptom 1596 1603 slowing E65 Sign_symptom:T109 T110 Sign_symptom 1608 1643 irregularity of background activity E66 Sign_symptom:T110 T111 Severity 1582 1586 mild R55 MODIFY Arg1:T111 Arg2:E65 T112 Diagnostic_procedure 1391 1393 CT E67 Diagnostic_procedure:T112 T113 Diagnostic_procedure 1373 1380 imaging E68 Diagnostic_procedure:T113 T114 Biological_structure 1367 1372 Brain R56 MODIFY Arg1:T114 Arg2:E68 T115 Detailed_description 1265 1270 serum R57 MODIFY Arg1:T115 Arg2:E35 T116 Diagnostic_procedure 1398 1401 MRI E69 Diagnostic_procedure:T116 T117 Sign_symptom 1419 1430 haemorrhage E70 Sign_symptom:T117 A9 POLARITY E70 NEG T118 Sign_symptom 1447 1451 mass E71 Sign_symptom:T118 A10 POLARITY E71 NEG T119 Biological_structure 1434 1446 intracranial R58 MODIFY Arg1:T119 Arg2:E71 T120 Diagnostic_procedure 2374 2381 ammonia E72 Diagnostic_procedure:T120 T121 Lab_value 2382 2392 normalised E73 Lab_value:T121 T122 Detailed_description 2368 2373 serum T123 Medication 1309 1318 valproate E74 Medication:T123 R59 MODIFY Arg1:T122 Arg2:E72 R60 MODIFY Arg1:E73 Arg2:E72 T124 Diagnostic_procedure 2397 2406 valproate E75 Diagnostic_procedure:T124 T125 Medication 2397 2406 valproate E76 Medication:T125 T126 Lab_value 2414 2423 decreased E77 Lab_value:T126 R61 MODIFY Arg1:E77 Arg2:E75 T127 Lab_value 2431 2448 therapeutic range E78 Lab_value:T127 R62 MODIFY Arg1:E78 Arg2:E75 T128 Diagnostic_procedure 2499 2513 investigations E79 Diagnostic_procedure:T128 T129 Detailed_description 2521 2531 urea cycle R63 MODIFY Arg1:T129 Arg2:E79 T131 Date 2546 2557 Three weeks E81 Date:T131 T132 Clinical_event 2562 2571 discharge E82 Clinical_event:T132 T130 Diagnostic_procedure 2619 2637 mental functioning E80 Diagnostic_procedure:T130 T133 Lab_value 2600 2606 stable E83 Lab_value:T133 R64 MODIFY Arg1:E83 Arg2:E80 T134 Sign_symptom 2673 2682 confusion E84 Sign_symptom:T134 A11 POLARITY E84 NEG T135 Sign_symptom 2686 2696 drowsiness E85 Sign_symptom:T135 A12 POLARITY E85 NEG T136 Sign_symptom 2729 2736 fatigue E86 Sign_symptom:T136 T137 Sign_symptom 2741 2761 walking difficulties E87 Sign_symptom:T137 T138 Sign_symptom 2783 2791 weakness E88 Sign_symptom:T138 T139 Biological_structure 2779 2782 leg R65 MODIFY Arg1:T139 Arg2:E88 T140 Detailed_description 2770 2778 residual R66 MODIFY Arg1:T140 Arg2:E88 T141 Diagnostic_procedure 2815 2826 amino acids E89 Diagnostic_procedure:T141 T142 Detailed_description 2809 2814 serum R67 MODIFY Arg1:T142 Arg2:E89 T143 Disease_disorder 2857 2877 carnitine deficiency E90 Disease_disorder:T143 T144 Diagnostic_procedure 2893 2907 acyl-carnitine E91 Diagnostic_procedure:T144 T145 Lab_value 2889 2892 low E92 Lab_value:T145 R68 MODIFY Arg1:E92 Arg2:E91 T146 Diagnostic_procedure 2924 2933 carnitine E93 Diagnostic_procedure:T146 T147 Detailed_description 2918 2923 serum T148 Detailed_description 2913 2917 free R69 MODIFY Arg1:T147 Arg2:E93 R70 MODIFY Arg1:T148 Arg2:E93 T149 Lab_value 2909 2912 low E94 Lab_value:T149 R71 MODIFY Arg1:E94 Arg2:E93 T150 Lab_value 2935 2946 14.2 μmol/L E95 Lab_value:T150 R72 MODIFY Arg1:E95 Arg2:E93 T151 Diagnostic_procedure 2989 2998 carnitine E96 Diagnostic_procedure:T151 T152 Detailed_description 2977 2982 total T153 Detailed_description 2983 2988 serum R73 MODIFY Arg1:T153 Arg2:E96 R74 MODIFY Arg1:T152 Arg2:E96 T154 Lab_value 2973 2976 low E97 Lab_value:T154 R75 MODIFY Arg1:E97 Arg2:E96 T155 Lab_value 3000 3011 19.9 μmol/L E98 Lab_value:T155 R76 MODIFY Arg1:E98 Arg2:E96 T156 Medication 3059 3068 carnitine E99 Medication:T156 T157 Administration 3054 3058 oral R77 MODIFY Arg1:T157 Arg2:E99 T158 Dosage 3069 3084 1 g twice daily R78 MODIFY Arg1:T158 Arg2:E99 T159 Date 3086 3100 Within 2 weeks E100 Date:T159 T160 Sign_symptom 3106 3114 symptoms E101 Sign_symptom:T160 A13 POLARITY E101 NEG T161 Diagnostic_procedure 3163 3172 carnitine E102 Diagnostic_procedure:T161 T162 Detailed_description 3157 3162 serum R79 MODIFY Arg1:T162 Arg2:E102 T163 Lab_value 3140 3153 normalisation E103 Lab_value:T163 R80 MODIFY Arg1:E103 Arg2:E102 T164 Diagnostic_procedure 3186 3195 carnitine E104 Diagnostic_procedure:T164 T165 Diagnostic_procedure 3218 3227 carnitine E105 Diagnostic_procedure:T165 T166 Detailed_description 3212 3217 total T167 Detailed_description 3181 3185 free R81 MODIFY Arg1:T167 Arg2:E104 R82 MODIFY Arg1:T166 Arg2:E105 T168 Lab_value 3231 3242 41.3 μmol/L E106 Lab_value:T168 T169 Lab_value 3196 3207 25.2 μmol/L E107 Lab_value:T169 R83 MODIFY Arg1:E107 Arg2:E104 R84 MODIFY Arg1:E106 Arg2:E105 R85 SUB_PROCEDURE Arg1:E104 Arg2:E102 R86 SUB_PROCEDURE Arg1:E105 Arg2:E102 T170 Medication 3249 3265 sodium valproate E108 Medication:T170 A14 POLARITY E108 NEG T171 Disease_disorder 3346 3371 schizo-affective disorder E109 Disease_disorder:T171 T172 Detailed_description 3321 3328 relapse R87 MODIFY Arg1:T172 Arg2:E109 T173 Medication 3413 3422 valproate E110 Medication:T173 T174 Dosage 3423 3437 1 g once daily R88 MODIFY Arg1:T174 Arg2:E110 T175 Medication 3452 3473 carnitine supplements E111 Medication:T175 T176 Detailed_description 3442 3451 long-term R89 MODIFY Arg1:T176 Arg2:E111 T177 Sign_symptom 3405 3409 well E112 Sign_symptom:T177 R90 AFTER Arg1:E2 Arg2:E1 * OVERLAP E1 E3 E4 E5 E6 E7 R91 AFTER Arg1:E7 Arg2:E8 * OVERLAP E8 E9 E10 E11 R92 BEFORE Arg1:E11 Arg2:E12 * OVERLAP E12 E13 E14 E15 R93 BEFORE Arg1:E15 Arg2:E19 * OVERLAP E19 E16 E17 E18 E20 E22 E23 E24 E25 E26 E29 E30 E31 E32 E27 E28 E34 E33 E35 E74 E39 E68 E70 E71 E47 E46 E65 E66 E114 T41 Lab_value 853 865 unremarkable E113 Lab_value:T41 R13 MODIFY Arg1:E113 Arg2:E24 R94 SUB_PROCEDURE Arg1:E67 Arg2:E68 R95 SUB_PROCEDURE Arg1:E69 Arg2:E68 T178 Medication 1659 1669 medication E114 Medication:T178 R96 BEFORE Arg1:E114 Arg2:E40 * OVERLAP E40 E41 E42 E50 E51 E44 R97 BEFORE Arg1:E44 Arg2:E53 * OVERLAP E53 E54 R98 BEFORE Arg1:E54 Arg2:E57 * OVERLAP E57 E56 E58 E59 E60 E72 E75 E76 R99 BEFORE Arg1:E76 Arg2:E63 * OVERLAP E63 E64 R100 BEFORE Arg1:E64 Arg2:E79 R101 BEFORE Arg1:E79 Arg2:E81 R102 AFTER Arg1:E81 Arg2:E82 R103 BEFORE Arg1:E82 Arg2:E80 * OVERLAP E80 E84 E85 E86 E87 E88 R104 BEFORE Arg1:E88 Arg2:E89 * OVERLAP E89 E90 E91 E93 E96 R105 BEFORE Arg1:E96 Arg2:E99 R106 BEFORE Arg1:E99 Arg2:E100 * OVERLAP E100 E101 E102 R107 BEFORE Arg1:E102 Arg2:E108 R108 BEFORE Arg1:E108 Arg2:E109 R109 BEFORE Arg1:E109 Arg2:E112 * OVERLAP E112 E110 E111