1. Surgical Pathological Conference Infective Endocarditis with Brain Abscesses (2006-05-25) 神經內科 洪國華

2. General Data Name: 金 X X Age: 50 y/o Marital Status: Married Gender: Male Tribe: Paiwan Chart Number: 74045442 Date of Admission: 2006-02-24 Date of Discharge: 2006-03-24

3. Clinical Course 2006-01-26Called at Taitung Hospital with low back pain 2006-01-30Intubated  ICU 2006-02-??B/C: MRSA 2006-02-??Right hemiplegia 2006-02-23Brain CT: Brain abscess  Transferred to MMH-TT

5. MER on 2006-02-23 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=515000 Glu=138 BUN/Cr=14/0.6 Na/K=137/3.2 PT INR=1.14 aPTT=35.3 (control=32.4)

6. Clinical Course 2006-02-24Brain CTBrain CT Removal of brain tumor Extraventricular drainage Culture of abscess: MRSA Culture of blood: No growth x II 2006-02-25Cardiac echo: MV vegetation with moderate-to-severe MR

7. Pre-contrast CT scan of brain on 2006-02-24

8. Post-contrast CT scan of brain on 2006-02-24 Back to 2006-02-24

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

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

11. Clinical course 2006-03-25 ~ 2006-03-1Afebrile GCS=8~10 Rt hemiplegia Normal BP HR around 100 2006-03-02 (W5)T=38.5 o C GCS=7~10 2006-03-04 (W7)GCS=5~6

12. Pre-contrast CT scan of brain on 2006-03-06

13. Post-contrast CT scan of brain on 2006-03-06

14. Clinical Course 2006-03-06 ~ 2006-03-20Fever off and on Quadriplegia GCS=4~5 2006-03-20WBC=7600 Hb=11.0 BUN/Cr=12/0.6Na/K=144/3.6 2006-03-21Brain CT 2006-03-22Hypotension 2006-03-24Passed away

15. Pre-contrast CT scan of brain on 2006-03-21

16. Post-contrast CT scan of brain on 2006-03-21

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