Table of Contents
Washington University Experience | PERIPHERAL NEUROPATHY | 11 VASCULITIS - VASCULOPATHY | 2 Vasculopathy | 10A0 Case 10 History
Case 10 History ---- The patient was a 61 year old man with chronic diarrhea and a history of colon resection with ostomy takedown in 2002, who presented with a three week history of infection with Clostridium difficile being treated with metronidazole. His family reported the patient had mental status changes marked by cognitive slowing beginning approximately one week prior to admission. Three days prior to admission the patient began experiencing word-finding difficulties and headache which was not relieved with Tylenol. Two days prior to admission, the patient was noted to be markedly agitated and confused, prompting evaluation at the local ER. At the OSH, the patient was noted to have a non-focal neurological exam, an unremarkable non-contrast head CT and serum sodium of 130 and platelets of 87-94K. CSF studies were all reported as normal. The patient was placed on ceftriaxone, acyclovir, continued on metronidazole and arranged for transfer to BJH. Follow up of pending lab results indicated that the patient had a negative CSF HSV PCR but a positive HSV IgG. The patient had a decreased level of arousal, requiring increased amounts of stimulation to awaken. He was also noted to move his left side less vigorously in response to noxious stimuli. He was intubated and transferred to the NNICU where his mental status continued to deteriorate. A non-contrast head CT obtained on June 1, 2007 demonstrated bilateral hemorrhages, midline shift and mild subfalcine herniation. Additional MRI findings included evidence of a right-sided subdural hematoma and right-sided subarachnoid hemorrhage. Two days later the family opted to withdraw care.
