ERPocketbooks

AMS after Shingles

UNFINISHED CASE: COME BACK LATER

Scroll to bottom for case answer and E-meducation

History:

A 54-year-old female on acyclovir for 1 week for V2 facial shingles is brought to the ED by family for confusion and excessive sleepiness.
She denies any fever or headache but did vomit once

Exam:

Vital signs were normal.
Physical exam was normal except for a crusted Zostiform rash to the right face and lack of animation.
She is oriented x 4 but slow to respond

Testing:

QUESTIONS:

SCROLL DOWN FOR ANSWERS & 1-MINUTE CONSULT

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A to Z 3rd ed book cover

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ANSWERS:

What does the case image image show? Brain MRI w/o contrast showed: Bilateral thalamic and basal ganglia edema c/w encephalitis. Marked congestion of deep venous structures. Brain MRI with contrast showed: shelf thrombosis and occlusion of the straight and left transverse sinuses. Bilateral thalamic and basal ganglia edema suspicious for venous occlusion. Brain MRV showed: Left transverse sinus and straight sinus thrombosis and occlusion.
What should you do next? First an LP which was done and showed slightly xanthochromic CSF with the following cell counts: 580 RBC, 22 WBC (74% PMN’s). Next, call a ID, give IV acyclovir and admit the patient
Where can I get a quick refresher on this topic? See highlighted area below

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