Case 102 -- Mental Status Changes and Severe Occipital Headache

Contributed by Andrew P. Lieberman, Robert I. Grossman*, and Ehud Lavi
Published on line in April 1997
    Department of Pathology and Laboratory Medicine and *Department of Radiology
    University of Pennsylvania School of Medicine.


PATIENT HISTORY:

A 32 year old man with symptoms of an upper respiratory infection one week prior presented with mental status changes and a severe occipital headache of two days duration. On examination, his neck was supple, he displayed diffuse hyperreflexia and bilateral extensor plantar responses. Lumbar puncture revealed an opening pressure of 410 mm H2O, a white cell count of 81 per HPF (differential 37% neutrophils, 55% lymphocytes), a red cell count of 4 per HPF, mildly elevated protein and normal glucose concentrations. The patient was treated with decadron, ceftriaxone, ampicillin, acyclovir and dilantin. His symptoms rapidly progressed and he was declared brain dead the following day.


RADIOLOGY

MICROSCOPIC DESCRIPTION

FINAL DIAGNOSIS


Case 

IndexCME Case StudiesFeedbackHome