Chronic meningitis presenting with acute obstructive hydrocephalus.
A previously healthy 24-year-old woman presented to the Emergency Department unresponsive with a Glasgow Coma Scale score of 4 and evidence of brainstem herniation. She was intubated and hyperventilated. Computed axial tomography scan of the brain demonstrated four-chamber hydrocephalus. Continued hyperventilation and mannitol diuresis were sufficient to arrest the impending herniation while emergent ventriculostomy was arranged. The patient recovered without sequelae and ultimately received a diagnosis of chronic idiopathic meningitis. This case highlights a rarely diagnosed disorder that presented with an acutely life threatening condition.
Birkhahn
Robert H
RH
Department of Emergency Medicine, New York Methodist Hospital, Brooklyn, New York 11215, USA.
Sweeny
Angela H
AH
Lopez
Olivia
O
D000208:Acute Disease; D000328:Adult; D002908:Chronic Disease; D003937:Diagnosis, Differential; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D006849:Hydrocephalus / Q000175:diagnosis / Q000209:etiology*; D006985:Hyperventilation; D019586:Intracranial Hypertension / Q000209:etiology / Q000628:therapy; D008353:Mannitol / Q000627:therapeutic use; D008581:Meningitis / Q000150:complications / Q000175:diagnosis*; D014057:Tomography, X-Ray Computed; D017287:Ventriculoperitoneal Shunt
D008353:Mannitol