Abstract
A 40-year-old man presents to the emergency department with headache, nausea and paresthesias, with subsequent fever and mental status change. Magnetic resonance imaging showed increased fluid-attenuation inversion recovery signal involving multiple areas of the brain, including the pons. This case takes the reader through the differential diagnosis of rhombencephalitis (inflammation of the hindbrain) with discussion of the unanticipated ultimate diagnosis and its treatment.
Highlights
A 40-year-old man presents to the emergency department with headache, nausea and paresthesias, with subsequent fever and mental status change
Magnetic resonance imaging showed increased fluid-attenuation inversion recovery signal involving multiple areas of the brain, including the pons. This case takes the reader through the differential diagnosis of rhombencephalitis with discussion of the unanticipated ultimate diagnosis and its treatment. [Clin Pract Cases Emerg Med. 2020;4(4):499–504]
When a patient presents with headache, fever, and neurological symptoms, such as altered mental status, this is extremely concerning for encephalitis or meningoencephalitis
Summary
Magnetic resonance imaging showed increased fluid-attenuation inversion recovery signal involving multiple areas of the brain, including the pons. CASE PRESENTATION (Dr Rubenstein) A 40-year-old male was brought by a friend to the emergency department (ED) for evaluation with a chief complaint of headache. The patient was alert, oriented, and uncomfortable but non-toxic appearing on the initial exam His temperature was 36.8° Celsius (C), with a heart rate of 71 beats per minute, blood pressure (BP) of 139/83 millimeters (mm) of mercury, and an oxygen saturation of 98% on room air with a respiratory rate of 16 breaths per minute. A. 40-year-old Male with a Headache and AMS papular rash was noted on his lower extremities (Image). 40-year-old Male with a Headache and AMS papular rash was noted on his lower extremities (Image) It did not involve the palms or soles.
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