A 30-year-old previously healthy man presented to the emergency department with a fever and recurrent vomiting for 2 days followed by altered sensorium for 6 h, a history that was provided by his spouse. There was no history of seizures or recent travel. The physical examination revealed that he was febrile (38.3°C [101°F]) with a pulse of 112 beats/min, a blood pressure of 146/98 mm Hg, a respiratory rate of 32 breaths/min, and there were no rashes anywhere on the body. A neurologic examination revealed obtunded sensorium (Glasgow coma scale score 6/15), and the motor, sensory, and cerebellar system could not be examined because of altered mentation. There was hyperreflexia and neck rigidity. Cardiac, pulmonary, and abdominal examinations were within normal limits. A clinical possibility of meningo-encephalitis was considered, with a differential diagnosis of bacterial or viral encephalitis. Viral encephalitis was considered to be more likely because the patient lived in a location where Japanese encephalitis was endemic. Cerebrospinal fluid analysis, including polymerase chain reaction testing for viral antibodies was positive for Japanese encephalitis. A contrast-enhanced magnetic resonance imaging scan was obtained, which revealed a distinctive finding that contributed to the determining diagnosis (Figure 1).
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Journal of Emergency Medicine
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Infectious disease surveillance update.Lancet Infect Dis. 2005; 5: 475-476
- Bilateral thalamic involvement in dengue infection.Neurol India. 2007; 55: 418-419
- Dengue encephalitis: “double doughnut” sign.Neurol India. 2017; 65: 670-671
Published online: May 28, 2019
Accepted: March 30, 2019
Received in revised form: March 6, 2019
Received: December 3, 2018
Reprints are not available from the authors.
© 2019 Elsevier Inc. All rights reserved.