A friend with history of opiate abuse, followed by severe anxiety related to her behaviour while on opiates, treated with antidepressants with no pos effect( serenely, lexapro, lyrica). Past hx. Of asthma, smoker, surgery for congenital malformation of foramen magnum. Mood improved following rivotril commencing. Shortly after that developed resp infection which progressed rapidly requiring antibiotics, steroids. Became very aggressive and manipulative and non compliant with hosp staff, condition continued to deteriorate became more psychotic, hypertensive, paranoid, increased resp distress.,uncoordinated movements. Ct brain showed fluid a base of brain. Bp treated I've labetalol. Steroids stopped( ? Cause of psychosis). Became more lethargic, eyes closed. MRI showed vasculitis with multiple mini strokes at front and base of brain. Commenced on methyl prednisone and anti cancer drug. Now a week later minimal improvements. ( has aspergillosis in sputum which is being treated) lumbar puncture neg.