Acute Neurologic Deterioration in a Young Man

DR. RICHARD T. SOKOLOV. A 26-year-old homosexual man was admitted to Cedars-Sinai Medical Center on 10 September 1989 because of decompensation of his mental status. The patient was in his usual state of good health until 3 days before admission, when he experienced fever, myalgia, headache, and chills. He was seen at a local hospital as an outpatient and instructed to take a medication that was antiinflammatory and analgesic. On the day of admission, the patient spoke incoherently, chewed on matchbooks, and pounded the floor with his fists. Paramedics administered naloxone and iv dextrose, but this treatment did not have an effect on the patient. In the emergency room, the patient was initially combative and had a generalized seizure that required his intubation.