PHYSICAL EXAMINATION

VS: T 37°C, P 83/min, R 14/min, BP 136/80 mmHg

PE: Young male in moderate distress due to headache; neurologic exam was normal.

LABORATORY STUDIES

Blood

Hematocrit: 45%

WBC: 7200/μL

Differential: 52% PMNs, 23% lymphs, 12% eosinophils

Blood gases: Normal

Serum chemistries: Normal

Imaging

A CT scan of his brain revealed an intracranial calcified cyst, and further imaging with MRI confirmed the presence of similar lesions, some with a scolex visible (Fig. 64-1).

FIGURE 64-1 Head MRI scan. Note an intracranial cyst and a scolex (arrowhead) in the right occipital lobe.

(Courtesy of Dr. Paul Southern, Departments of Pathology and Medicine, University of Texas Southwestern Medical Center, Dallas, TX.)

Table 64-1 lists the likely causes of illness (differential diagnosis). The presumptive diagnosis should be on the basis of clinical picture and epidemiologic information. The likelihood of exposure during foreign travel, and characteristic findings on CT or MRI scans, are adjuncts to clinical diagnosis. Lumbar puncture and peripheral blood collection are an essential beginning of investigation. Microbiologic investigation may include

• Gram stain and acid-fast stain of CSF

• Cultures of CSF and blood for bacteria, fungi, mycobacteria

• Antibody detection (e.g., immunoblot assay of IgG in serum or CSF specific for the invasive stage of a parasite)

• In failed tests above

• Cryptococcal antigen in CSF and serum

• CSF VDRL

• Serologic tests for others included in differential diagnosis

TABLE 64-1 Differential Diagnosis and Rationale for Inclusion (consideration)

Brain abscess

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