Bacterial meningitis complicated by seizures and confusion by ProQuest


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									                                 Clinical Challenge
             Bacterial meningitis                                                CASE
                                                                                                 Ms. M, aged 73 years, was
                                                                                                 brought to the neuroscience
                                                                             clinic by her daughters. She was alert, pleasantly
             complicated by                                                  confused, and using a wheelchair for mobility
                                                                             because of concurrent right knee antalgia and
             seizures and confusion                                          edema. The initial physical exam was unremark-
                                                                             able. Ms. M’s daughters provided details about
             CASE AND ANALYSIS BY STEPHANIE                                  her medical history, which was significant for an
             CHRISTIAN-LOBLEY, FNP-BC, APNP, CCRN, CNRN                      idiopathic transnasal cerebrospinal fluid (CSF)
                                                                             leak that was repaired via bifrontal craniotomy
             The seizures began following surgery to                         20 years ago. Since that time, she has experienced
                                                                             recurrent episodes of bacterial meningitis. The
             repair a cerebrospinal fluid leak.                               last episode occurred approximately two weeks
                                                                             earlier, and she was admitted to the hospital for
                                                                             treatment. After discharge, she and her daughters
                                                                             reported colorless transnasal drainage consistent
                                                                             with CSF.
                                                                               At the neuroscience clinic, MRI revealed
                                                                             a 3.4-cm peripherally enhancing extra-axial
                                                                             fluid collection within the anterior aspect of
                                                                             the left middle cranial fossa (likely representing
                                                                             abscess or infected arachnoid cyst) and areas of
                                                                             leptomeningeal enhancement within the skull.
                                                                             MRI indicated possible incomplete treatment of
                                                                             Ms. M’s recent bacterial meningitis. Additionally,
                                                                             a right sphenoid sinus surgical defect at the base
                                                                             of the skull was identified as a potential source
                                                                             of the current CSF leak.
                                                                               Ms. M was admitted to the neurosurgical
                                                                             nursing ward in anticipation of repair of the
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