Case 19-2014: 19-Year-Old Woman with Headache, Fever, Stiff Neck, and Mental-Status Changes Mark P. Gorman, M.D., Sandra P. Rincon, M.D., and Virginia M. Pierce, M.D
Presentation of Case a 19-vear -old woman headache, fever, photophobia, neck stiffness and mental- status changes
Presentation of Case • a 19-year-old woman • headache, fever, photophobia, neck stiffness, and mental-status changes
Presentation of Case Before admission headache and reportedly vomited and nausea developed fainted after standing up 7 6 was seen at the emergency department of a hospital in Massachusetts
Presentation of Case headache and nausea developed was seen at the emergency department of a hospital in Massachusetts reportedly vomited and fainted after standing up -7 -6 -4 Before admission
Presentation of Case -6 days The physical examination and laboratory test results were normal Intravenous fluids and ketorolac were administered. with improvement a diagnosis of tension or migraine headache was made She returned to her college dormitory
Presentation of Case • -6 days • The physical examination and laboratory test results were normal. • Intravenous fluids and ketorolac were administered, with improvement. • A diagnosis of tension or migraine headache was made. • She returned to her college dormitory
Presentation of Case Before admission headache and reportedly vomited and nausea developed fainted after standing up 7 6 was seen at the emergency department of a hospital in Massachusetts
Presentation of Case headache and nausea developed was seen at the emergency department of a hospital in Massachusetts reportedly vomited and fainted after standing up -7 -6 -4 Before admission
Presentation of Case -4 days She returned to the hospital that night Examination revealed a temperature of 38.4 c and was otherwise normal The hematocrit, hemoglobin level, platelet count, and results of renal- and liver-function tests were normal Testing for mononucleosis, streptococcal pharyngitis and influenza was negative and urinalysis revealed blood that was consistent with menses
Presentation of Case • -4 days • She returned to the hospital that night. • Examination revealed a temperature of 38.4°C and was otherwise normal. • The hematocrit, hemoglobin level, platelet count, and results of renal- and liver-function tests were normal. • Testing for mononucleosis, streptococcal pharyngitis, and influenza was negative, and urinalysis revealed blood that was consistent with menses
Presentation of Case -4 days Intravenous fluids, ketorolac, metoclopramide(胃复安) and ondansetron(昂丹司琼) were administered,with some improvement a diagnosis of possible migraine headache was made and the patient returned to her dormitory
Presentation of Case • -4 days • Intravenous fluids, ketorolac, metoclopramide(胃复安), and ondansetron（昂丹司琼） were administered, with some improvement. • A diagnosis of possible migraine headache was made, and the patient returned to her dormitory
Presentation of Case Before admission Another episode of the fever persisted syncope occurred 3 amoxicillin and after the patient ibuprofen arose from bed emergency department of another hospital that is affiliated with this hospital
Presentation of Case the fever persisted after the patient arose from bed Before admission -3 amoxicillin and ibuprofen -1 Another episode of syncope occurred emergency department of another hospital that is affiliated with this hospital
Presentation of Case -1 days a bilateral parietal headache that was the worst of her life fever nausea photophobia vomiting chills dizziness with night sweats position changes neck stiffness(2 days a mild sore throat no cough or abdominal pain
Presentation of Case a bilateral parietal headache that was the worst of her life fever photophobia chills night sweats nausea vomiting dizziness with position changes neck stiffness (2 days) a mild sore throat no cough or abdominal pain -1 days
Presentation of Case 1 day Physical examination ·T<37.1°C BP: 97/64 mm Hg P: 99 bpm R: 20 breaths/min SpO2: 96%(breathing ambient air) the remainder of the examination was normal
Presentation of Case Physical examination • T<37.1°C • BP:97/64 mm Hg • P:99 bpm • R:20 breaths/min • SpO2:96%(breathing ambient air) • the remainder of the examination was normal. -1 day