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.