Woman With Fever, Headache, and Ataxia

Abstract

A 53-year-old woman with an unremarkable medical history presented to the emergency department with 2 weeks of right-sided frontal headache and right-sided neck pain and 3 days of fever, dizziness, nausea, vomiting, and inability to ambulate. Her vital signs revealed a temperature of 38 °C (100.4 °F). Physical examination revealed pain with neck flexion, inability to ambulate without assistance, and significant right-sided dysmetria on finger-nose-finger testing. Brain magnetic resonance imaging revealed an acute right cerebellar infarct secondary to nonocclusive right sigmoid sinus and internal jugular vein thrombosis, also confirmed on computed tomography (Figure 1, Figure 2).