Article Text
Statistics from Altmetric.com
Case description
A 48-year-old man was brought to our unit with deteriorating consciousness but no available history. His Glasgow Coma Scale score was 11/15 (E3, V4, M4). A limited neurological examination identified neck stiffness with normal upper and lower limbs except for extensor plantar responses. Cranial nerve examination was also limited, but with no obvious ophthalmoplegia, facial weakness, wasting of muscles of mastication or jaw drop. Following intubation, he was found to have persistently elevated inflammatory markers but negative blood and urine cultures. MR scan of brain with contrast showed multiple ring-enhancing lesions and meningeal enhancement without hydrocephalus (figure 1). Cerebrospinal fluid (CSF) analysis showed a raised protein, with lymphocytosis and low glucose. Nucleic acid amplification test of CSF for tuberculosis was positive.
MR scan of brain showing multiple …
Footnotes
Contributors All authors contributed equally to this article.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned. Externally peer reviewed by Aaron Berkowitz, Los Angeles, USA.
Read the full text or download the PDF:
Other content recommended for you
- Recognising facial onset sensory motor neuronopathy syndrome: insight from six new cases
- Isolated hypesthesia in the right V2 and V3 dermatomes after a midpontine infarction localised at an ipsilateral principal sensory trigeminal nucleus
- Hemiageusia from an ipsilateral multiple sclerosis plaque at the midpontine tegmentum
- Differential innervation of tissues located at traditional acupuncture points in the rat forehead and face
- Imaging diagnosis: chronic unilateral trigeminal neuropathy masquerading as a trigeminal peripheral nerve tumour on MRI in a dog
- Trigeminocardiac reflex caused by selective angiography of the middle meningeal artery
- Trigeminocardiac reflex during the percutaneous injection of ethylene vinyl alcohol copolymer (Onyx) into a juvenile nasopharyngeal angiofibroma: a report of two cases
- Pontine lesions mimicking acute peripheral vestibulopathy
- Work out where the problem is in the brainstem using ‘the rule of 4’
- Sjögren's syndrome with trigeminal neuropathy: motor involvement