The Diagnostic Conundrum and Treatment Dilemma of a Patient With a Rapidly Progressive Encephalopathy

摘要

A 45-year-old man of the Yakama Nation tribe without significant medical history had an abrupt onset headache that progressed over a week. He presented to an emergency department and a noncontrast head computerized tomography (CT) was unremarkable except for mild ethmoid sinus disease. One week later, the patient developed neck stiffness, fever to 101.6 degrees F, chills, and body aches. The patient's partner reported episodes of confusion with auditory and visual hallucinations, seeing things on the wall, and thinking he was covered in chocolate.After 2.5 weeks into the course of illness, the patient sought care from his primary care physician who referred him to a local emergency department. In the emergency department, the patient was afebrile though ill appearing with diaphoresis. He had fluent speech, normal comprehension, and intact memory and concentration. He was noted to have an unsteady tandem gait and positive Romberg sign. The rest of the neurologic examination was unremarkable.