A Sad Story - Video

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Identifier walsh_2018_s2_c3
Title A Sad Story - Video
Creator Jason Peragallo, MD
Subject Meningo-encephalitis, 6th nerve palsy, Infectious, Increased intracranial pressure, Nystagmus
Presenting Symptom A healthy 6-year-old boy had a two-week history of progressive headaches associated with nausea and vomiting. An ER diagnosed allergic rhinitis, treated with augmentin and steroids, however his symptoms worsened. At a second ER he was febrile to 103F. A classmate was recently diagnosed with Erlichiosis, and our patient was given; doxycycline. Brain MRI with and without contrast was normal. CBC was normal. A lumbar puncture revealed 286; WBC (75%lymphs) , 1 RBC, protein 65, glucose 24, negative gram stain. He was diagnosed with aseptic meningitis. Blood culture, CSF culture, CMV, EBV, Arbovirus, RMSF, Erlichia chaffeensis, Bartonella, and West Nile virus were; negative. He developed binocular horizontal diplopia. Neuro-ophthalmology was consulted. Afferent visual function was normal, extraocular motility was full, he had horizontal gaze-evoked nystagmus, an alternating; esotropia, and mild bilateral disc edema. Diagnosis was mild sixth nerve palsy from elevated ICP in the setting of; meningitis. Neurologic examination was otherwise unremarkable. Head CT showed mild communicating; hydrocephalus. Repeat LP showed opening pressure 33cmH2O, WBC 366 (60% lymphs), 4 RBC, protein 180, glucose 4, negative Cryptococcus, VDRL, HIV, HSV, TB by PCR. IV ceftriaxone and acyclovir were initiated. MRI; brain and spine revealed leptomeningeal enhancement and hydrocephalus. His sixth nerve palsies worsened. He developed bowel and bladder incontinence, and clincally deteriorated. Rifampin, isoniazide, pyrazinamide, and; ethambutol were initiated, with vancomycin and steroids. A right EVD was placed for hydrocephalus. Quantiferon Gold, urine and blood histoplasma antigen were negative. He began complaining of vision loss. Repeat head CT revealed dilation of the left lateral ventricle, and a left EVD was placed. He was intubated and sedated. Amphotericin was added. At this point the patient was covered for bacterial, viral, TB, and fungal meningitis. His mother noted he was exposed to well water and frequently played outside in the dirt.
Date 2018-03
Language eng
Format video/mp4
Source 2018 North American Neuro-Ophthalmology Society Annual Meeting
Relation is Part of NANOS Annual Meeting 2018: Frank B. Walsh Session 2
Collection Neuro-ophthalmology Virtual Education Library: NOVEL http://NOVEL.utah.edu
Publisher Spencer S. Eccles Health Sciences Library, University of Utah
Holding Institution North American Neuro-Ophthalmology Association. NANOS Executive Office 5841 Cedar Lake Road, Suite 204, Minneapolis, MN 55416
Rights Management Copyright 2018. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright
ARK ark:/87278/s6gb66nk
Contributor Primary Jason Peragallo, MD
Setname ehsl_novel_fbw
ID 1320231
Reference URL https://collections.lib.utah.edu/ark:/87278/s6gb66nk
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