RT Book, Section A1 Shah, Syed Omar A1 Rincon, Fred A2 Lee, Kiwon SR Print(0) ID 1143954502 T1 CNS Infection T2 The NeuroICU Book, 2e YR 2017 FD 2017 PB McGraw-Hill Education PP New York, NY SN 9780071841443 LK neurology.mhmedical.com/content.aspx?aid=1143954502 RD 2024/03/29 AB An otherwise healthy 29-year-old man is brought in to the emergency department (ED) because of 2 days of headache, flu-like symptoms, fever, and change in sensorium. On arrival at the ED his vital signs were temperature, 103.3°F; heart rate, 138 bpm; respiratory rate, 24 to 32 breaths per minute; blood pressure, 88/48 mm Hg; saturation, 88% (room air), and Glasgow Coma Scale (GCS), 10. The patient’s general examination revealed a patient in mild distress, with injected conjunctivae, erythematous throat, pallor without cyanosis, petechial rash in lower extremities, nuchal rigidity, and a normal cardiac and lung examination. His abdomen was mildly tender, but no peritoneal signs were elicited. He was stuporous but arousable to a loud voice and strong painful stimulation, and he was able to follow some simple commands, although inconsistently. Cranial nerves were normal, and fundus did not show papilledema. He was localizing briskly with the upper extremities and withdrawing appropriately with both lower extremities. Reflexes were three fourths throughout. A Foley catheter was inserted and obtained only 10 mL of dark urine.