Contributed by Andrew P. Lieberman, Robert I. Grossman*, and Ehud Lavi
Department of Pathology and Laboratory Medicine
and *Department of Radiology, University of Pennsylvania School of Medicine.
A 32 year old man with symptoms of an upper respiratory infection one week prior presented with mental status changes and a severe occipital headache of two days duration. On examination, his neck was supple, he displayed diffuse hyperreflexia and bilateral extensor plantar responses. Lumbar puncture revealed an opening pressure of 410 mm H2O, a white cell count of 81 per HPF (differential 37% neutrophils, 55% lymphocytes), a red cell count of 4 per HPF, mildly elevated protein and normal glucose concentrations. The patient was treated with decadron, ceftriaxone, ampicillin, acyclovir and dilantin. His symptoms rapidly progressed and he was declared brain dead the following day.