Case History
Initial Presentation : A 28-year-old male presented to our hospital with a five-day history of headache, fever, confusion, and frequent stiffening and jerking movement of the whole body. At presentation, he was tachycardic, tachypneic, febrile and had diffuse rhonchi with peripheral oxygen saturation of 75% on atmospheric air. His Glasgow Coma Scale was 7/15(E4, V2 M1). He was intubated for airway protection and started on Acyclovir for complicated viral meningoencephalitis (CSF PCR was sent at presentation (Image 2). After initial treatment, his GCS improved to 11/15 (E4, V2, M5) but still had left-sided body preference. He then started to experience a decline in GCS to 8/15 (E3, V1, M4), new onset anisocoria, and repeated episodes of generalized tonic-clonic seizure for which additional imaging with non-contrast CT(image 3C) and Brain MRI with MRV (Image 3E ) Both showed radiologic worsening and new MCA territory infarct.