A 19-Year-Old Woman with Headache, Fever, Stiff Neck, and Mental-Status Changes  

Oleh:

Gorman, Mark P. ; Rincon, Sandra P. ; Pierce, Virginia M.

Jenis: Article from Journal - ilmiah internasional
Dalam koleksi: The New England Journal of Medicine (keterangan: ada di Proquest) vol. 370 no. 25 (Jun. 2014), page 2427-2438.

Ketersediaan

Perpustakaan FK Nomor Panggil: N08.K.2014.01 Non-tandon: 1 (dapat dipinjam: 0) Tandon: tidak ada

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Isi artikel

Dr. Robin M. Jones (Neurology): A 19-year-old woman was admitted to the pediatric intensive care unit of this hospital in the autumn because of headache, fever, photophobia, neck stiffness, and mental-status changes. The patient had been well until 7 days before admission, when headache and nausea developed. She was seen at the emergency department of a hospital in Massachusetts 6 days before admission. 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, and she returned to her college dormitory. Two days later, the patient reportedly vomited and fainted after standing up. 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. Intravenous fluids, ketorolac, metoclopramide, and ondansetron were administered, with some improvement. A diagnosis of possible migraine headache was made, and the patient returned to her dormitory. The next day, the fever persisted, and the patient's parents, who had traveled from their home to be with her, administered amoxicillin (obtained from relatives who were physicians) and ibuprofen. The day before admission, another episode of syncope occurred, without head trauma, after the patient arose from bed. She went to the emergency department of another hospital that is affiliated with this hospital.

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