22 Year Old Confused American
Della Williams, M.D.
22 year old man works in oil fields (seismology team) working 6 weeks on and 3 weeks off for last two years. From Texas and very healthy. All of them drink a lot of beer all the time, usually. Several of the crew members not working directly with him) had developed chicken pox within the last several months. One man had a bad case of shingles (he had been immunosupressed for lymphoma treatment). The patient goes to Bankok to be with his Thia girlfriend whenever he is off. He was off and had been there for two weeks when, 1 day after visiting her parents in a Village in the north (one day there, no swimming ), he developed shaking chills and fever and was given antibiotics by a Thi ER physician who said his throat was red. Symptoms at that time were only fever, chills and severe headache.
Returned to Emirates on 22nd, no complaints, no headache nor fever. On 23rd semi collapsed in elevator at 2 PM with a shaking episode (not a GM sz and unclear what it was) and remained confused. Admitted to our hospita at 6 PM: globally confused with flavor of right parietal syndrome, combative, no insight nor judgment. LP done after CT showed hypodensity in right parietal white matter (no shift) no cells but protein of 65, LDH and CPK nl. By 10 PM had some dysphasia, more confused and difficult, requiring midazolam to handle him. Vital signs were normal except for tachycardia of 108. Chest X-ray, CBC, lytes, ESR normal. LFTs slightly elevated. Re-examined the CCT (without contrast) done on admission and convinced myself that venous sinus thrombosis might explain everything. We did a late night MRI/MRV/MRA. What do you think we found? Would like to hear a discussion and will post the pictures when I get them formatted.
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Revised June 12, 2001
(c) 2001 Medical College of Georgia