Surgical Pathological Conference Infective Endocarditis with Brain Abscesses ( ) 神經內科 洪國華

General Data Name: 金 X X Age: 50 y/o Marital Status: Married Gender: Male Tribe: Paiwan Chart Number: Date of Admission: Date of Discharge:

Clinical Course Called at Taitung Hospital with low back pain Intubated  ICU ??B/C: MRSA ??Right hemiplegia Brain CT: Brain abscess  Transferred to MMH-TT

MER on GCS=E 4 M 5 V E T 36.4 o C P 105 R 20 BP 136/87 pH=7.49 PCO 2 =43.5 PO 2 =82.0 HCO 3 =33.1 Hb=10.4 WBC=10400 (N/M/L=57/9/29) Plt= Glu=138 BUN/Cr=14/0.6 Na/K=137/3.2 PT INR=1.14 aPTT=35.3 (control=32.4)

Clinical Course Brain CTBrain CT Removal of brain tumor Extraventricular drainage Culture of abscess: MRSA Culture of blood: No growth x II Cardiac echo: MV vegetation with moderate-to-severe MR

Pre-contrast CT scan of brain on

Post-contrast CT scan of brain on Back to

Diagnosis Infective endocarditis, with moderate-to- severe mitral regurgitation and multiple brain abscesses, MRSA

Treatment Vancomycin 1gm IVD Q12h Claforan 2gm IVD Q4h Extraventricular drainage +/- surgical removal of brain abscess

Clinical course ~ Afebrile GCS=8~10 Rt hemiplegia Normal BP HR around (W5)T=38.5 o C GCS=7~ (W7)GCS=5~6

Pre-contrast CT scan of brain on

Post-contrast CT scan of brain on

Clinical Course ~ Fever off and on Quadriplegia GCS=4~ WBC=7600 Hb=11.0 BUN/Cr=12/0.6Na/K=144/ Brain CT Hypotension Passed away

Pre-contrast CT scan of brain on

Post-contrast CT scan of brain on

Diagnosis Infective endocarditis, with moderate-to- severe mitral regurgitation and multiple brain abscesses, MRSA