Case of the Month - July 2016

A 23-year-old man presented with a 5-day history of headache and photophobia, and 3 days history of fever and vomiting. The headache was predominantly frontal, and refractory to simple analgesia. The vomiting was not associated with any precipitant, and had occurred approximately 4 times per day since its onset.

The patient had no previous medical or surgical history of note, and described himself as being in perfect health prior to this episode. He had tested negative for HIV four months previously. He was not on any medications, and gave no history of alcohol, smoking or recreational drug use. He was unemployed and lived with his brother in a house in Soweto with full amenities. He was not sexually active, and had no travel history and no pets.

On examination, his blood pressure was 112/63 mmHg, his pulse was 67 beats per minute, and his temperature was recorded as 36.7°C. He had no oral lesions or stigmata of HIV. A neurological exam revealed meningism, with positive Kernig and Brudzinski signs. He was well-orientated and had a normal sensorium with no focal neurology.

Question 1: Is the clinical syndrome most compatible with a migraine, meningitis or encephalitis?

Continue to Answer 1