A 25-year-old woman was admitted with confusion, headache, and vomiting. Physical examination showed disorientation to time and place, difficulty following commands, and neck stiffness. Lumbar puncture revealed a cerebrospinal fluid (CSF) leukocyte count of 0.674/μL and a low CSF–blood glucose ratio. Ceftriaxone sodium administration was started empirically; CSF cultures grew Neisseria meningitidis. The second day, a sudden respiratory arrest occurred. No seizures were noted. Computed tomography revealed dilatation of the entire ventricular system, indicating communicating hydrocephalus (Figure). A right frontal external ventricular drain was placed for 5 days. The patient's confusion resolved after CSF drainage; however, a mild right hemiparesis and a right-sided Horner syndrome were noticed. Magnetic resonance imaging showed a focal zone of signal abnormality in the right dorsal aspect of the medulla oblongata, which had restricted diffusion, suggestive of cerebral infarction (Figure). Hemiparesis gradually improved over the course of hospitalization, but some numbness of the right hand remained.
Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more
Subscribe for full-text access to content from 1998 forward and a host of useful features
Activate your current subscription (AMA members and current subscribers)
Purchase Online Access to this article for 24 hours
Brain computed tomography (A and B) reveals communicating hydrocephalus with enlargement of the entire ventricular system, including the fourth ventricle. Axial fluid-attenuated inversion recovery–weighted magnetic resonance imaging shows hyperintense signal in the right dorsal part of the medulla oblongata, indicating edema (C) (arrow), and a slightly enlarged ventricular system (external ventricular drain in situ) with infectious debris in the lateral ventricles, suggesting extensive purulence (D) (arrow), and enhancement with gadolinium of the ependymal surface, suggestive of ventriculitis.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
Instructions
Thank you for submitting a comment on this article. It will be reviewed by JAMA Neurology editors. You will be notified when your comment has been published. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest* Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 6
Customize your page view by dragging & repositioning the boxes below.
More Listings atJAMACareerCenter.com >
and access these and other features:
Register Now
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Need assistance?
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.