PHYSICAL EXAMINATION

VS: T 38°C, P 86/min, R 16/min, BP 124/80 mmHg

PE: On exam, he was confused and unable to coherently answer questions. Pupils were equal and reactive, and his neck was supple. Neurologic exam revealed left arm and leg weakness, but further exam was difficult due to his lack of cooperation.

LABORATORY STUDIES

Blood

Serum chemistries: Normal

Imaging

A head MRI showed an irregular area of hemorrhagic necrosis in the right temporal lobe.

Table 61-1 lists the likely causes of illness (differential diagnosis). A clinical diagnosis of viral encephalitis was considered, based on symptoms such as fever, headache, altered mental state, and seizure. A definitive diagnosis of viral encephalitis relies on

• Virus isolation from CSF or brain

• Polymerase chain reaction (PCR)-based amplification of viral DNA from CSF

TABLE 61-1 Differential Diagnosis and Rationale for Inclusion (consideration)

Aseptic meningitis

Bacterial meningitis

Brain abscess

Cryptococcal meningoencephalitis

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