Low lean mass and sarcopenia are common in patients with IBD, and important to recognise as they predict osteopenia/osteoporosis. Grip strength testing should be incorporated into routine clinical practice to detect low lean mass deficits, which may go unrecognised using BMI alone.

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The next morning she was incontinent and unable to speak. On admission to the A&E department she had signs of a complete right hemiparesis.A CT head scan revealed a large intracerebral haemorrhage in the left frontoparietal region, with significant mass effect, and surrounding oedema with shift of the midline (see Fig. 1).She was given mannitol and dexamethasone before she underwent a left frontoparasaggital craniotomy for removal of the intracerebral clot. At operation a small angioma was found which was felt to be the source of the haemorrhage. Drug analysis detected no MDMA but amphetamine at a concentration of 0.07mgl-1. Subsequently her speech returned but she has only partial recovery of power in her right arm and leg.