Frontal Headache, Photophobia, Fever and Vomiting in a io-year-old Girl

摘要

A 1o-year-old girl presents to the emergency department with a 12-hour history of frontal headache, photophobia, fever, and vomiting. She also has yellow nasal discharge. She was hospitalized and treated for pneumococcal meningitis 3 years ago. There is no history of head trauma, family history of immunodeficiency, or other repetitive infections.Her vital signs are as follows: temperature, ioo.4°F (38.o°C); blood pressure, 118/81 mm Hg; pulse, 100 beats/min; and respiratory rate, 30 breaths/min. On physical examination she is covering her eyes and complaining of intense headache, and her speech is incoherent. Kernig and Brudzinski signs are positive. The results of fundus examination and the remaining neurologic examination are normal.