Case presentation
A 20-year-old male with no significant past medical history visited a tertiary referral collegiate hospital in Tehran on 5 June 2022, with severe headache (frontal, non-positional, pulsatile without any photophobia, phonophobia, and visual disturbances), nausea, vomiting, malaise, non-bloody sputum for 2 weeks and significant weight loss of about 15 kg in recent two months. His familial history was negative for TB or lung malignancies. At admission, his vital signs were in the normal range. In physical examination, his conjunctiva was pale along with cervical and supraclavicular lymphadenopathies. Other neurological and non-neurological examinations were normal.
Due to the severe headache which last for 30 minutes each time and repeat every 3 hours neurological consultation was done. In MRI, multiple hyperdense lesions were seen (Figure 1).