1. Case: “My Head is Sore” Department of Clinical Microbiology and Infectious Diseases 2010

2. 6/1/2016Page 2 Presenting symptoms A 38-year-old woman was brought to Casualty by family with a complaint of low-grade fever and malaise. The day before, she had complained of a severe headache with neck stiffness, and was witnessed having seizures in the past 24 hours. Thereafter she became drowsy and difficult to communicate with.

3. 6/1/2016Page 3 On examination  General: Thin Generalised lymphadenopathy, oral thrush Temp. 39 o  Systemic: CNS GCS of 10/15 Meningism No focal deficits. Respiratory: Harsh breath sound bilaterally Rest of exam NAD

4. 6/1/2016Page 4 Assessment What is your working hypothesis? –What additional questions might you ask to clarify your hypothesis? What are the differential diagnoses? What investigations would you request and how will they help to confirm or eliminate your hypothesis?