Encephalitis
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Encephalitis
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Questions
USMLE® Step 1 style questions USMLE
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A 25-year-old man is brought to the emergency department by his partner following an episode of generalized convulsions. His partner reports that for the past 3 days, the patient has had a high fever and severe headache accompanied by nausea and vomiting. She also mentions that he started complaining of smell and taste changes. A few days ago, they came back from a trip to California in which they hiked and swam in lakes. Temperature is 38.9°C (102°F), pulse is 80/min, and blood pressure is 135/85 mmHg. On physical examination, the patient is confused and unresponsive. Pupils are equal and react sluggishly to light. Brudzinski sign is positive. A lumbar puncture is performed, and cerebrospinal fluid (CSF) analysis shows the following:
Gram stain of the CSF is negative. Head imaging results are nonspecific. Which of the following is the most likely causative organism?
| Cerebrospinal fluid | |
| Opening pressure | 300 mm H2O |
| Protein | 130 mg/dL |
| Glucose | 20 mg/dL |
| RBCs | Numerous |
| WBC count | 1500/µL with polymorphonuclear predominance |
| Neutrophils | 80% |
Gram stain of the CSF is negative. Head imaging results are nonspecific. Which of the following is the most likely causative organism?
External References
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Summary
Encephalitis is an acute inflammation of the brain. It can be caused by a viral, bacterial, or parasitic infection, or it can be a result of autoimmune disorders. Symptoms include fever, headache, nausea, vomiting, and fatigue. In some cases, encephalitis can lead to seizures, coma, and death.