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:
- Basic labs were normal
- Brain MRI is shown below
QUESTIONS:
- What does the case image image show? (click two times to enlarge)
- What should you do next?
- Where can I get a quick refresher on this topic? See highlighted area below
SCROLL DOWN FOR ANSWERS & 1-MINUTE CONSULT
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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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E-meducation for medical topic of this case: Read the yellow highlighted area of the page-shot below from our #1 title, the Emergency Medicine 1-Minute Consult Pocketbook
RELATED ARTICLES:
- https://www.ncbi.nlm.nih.gov/pubmed/29159001
- Clinical analysis and misdiagnosis of cerebral venous thrombosis