50 years old man was admitted to the infectious diseases hospital with complaints of fever up to 38-39, headache, double vision, difficulty swallowing food and water, numbness of the skin of the feet. Disease started 5 days ago, when there was a sudden headache, fever up to 38 - he took 1 pill of ibuprofen with a short-term effect. The next day he was fibrile again and developed nausea, vomiting up to 10 times per day, weakness, unsteady gait. He refused having diarrhea and pain in the stomach. He didnt visit a doctor. The next day came the double vision, hoarseness and nasalized speech voices, срщлштп when try to swallow food or drink water due to which he didnt take any food. Every day he had fever up to 39 ° C and his headache gradually increased. Neurological status at admission: patient councious, get in to contact, adequate, dysarthria is present. Right palpebral fissure was less the left, pupils R=L, pupils reaction to light is live and simmetrical. Paresis of left n. abducens was found. Horizontal and vertical nystagmus with a rotational component, nasolalia and dusphagia were present. Tendon reflexes more vivid on a right. Palanisamy sample performs with the intention on the left. No muscles paresis. Mri was performed (on pictures). Lumbar puncture: color - opalescent, pleocytosis - 762*10/6/l, neutrophils 58%, lymphocytes 42%, protein - 2,1 g/l (normal less the 0,3 g/l), glucose 2,1 mmol/l (blood glucose 5,3 mmol/l). What is a diagnosis?
Posted on: Sun, 28 Sep 2014 07:57:51 +0000
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