Intracranial Aneurysms From Presumed Infective Endocarditis: The Dilemma of Persistently Negative Cultures

摘要

Paramedics were called when a 39-year-old man had a witnessed generalized tonic-clonic seizure. They found him comatose with a fixed and dilated left pupil and performed emergent endotracheal intubation. On arrival to the hospital, he was afebrile. His blood pressure was 175/125 mm Hg, pulse 86 beats per minute, and oxygen saturation, 100% on 100% Fio2. He had complained to his wife earlier in the day of headaches and "feeling hypertensive." Although prescribed a thiazide and angiotensin-converting enzyme inhibitor for hypertension, he was nonadherent and his hypertension was poorly controlled. His past medical history was otherwise unremarkable. He had emigrated from Mexico 2 years earlier and worked preparing food. General examination demonstrated an obese middle-aged man. He had a regular rhythm without murmur and had no skin or nail lesions. Neurologic examination revealed a Glasgow Coma Scale of 4 for extensor posturing, and his pupils were now 7 mm bilaterally and unresponsive to light.