Course 3, Case 7
Kas 3-7E: Dizziness, headache and fevers following a tick bite
Male, 25 years, healthy up to now
Family history: No important data.
Personal history: Common child diseases, left forearm fracture in childhood, otherwise
negative
No alergy
Professional history: Forest worker
Actual illness: Arriving to neurological examination because of a an increasing headache,
dizziness, weakness. Fever, fatiguability with intermittent nausea. Since yesterday severe
disturbance of gait and standing. Subjectively feeling intolerance to light and noise. Seven
days ago he had a transient fever lasting 2 days, 2-3 weeks ago he spotted having a tick.
Physical examination: Tired, slightly slower psychomotor tempo. He comes accompanied
and supported by another person. Cranial nerves – speech is saccadic, explosive,
dysrhythmical. Coarse nystagmus, accentuated with gazing to either side. Meningeal sighns::
robustly positive upper and lower meningeal sighns. Upper extremities – bilateral dysmetria
movements are dyssynergic, ataxia with the finger – nose test, dysdiadochokinesis. On lower
extremities similarly. Trunc ataxia when sitting. Standing very unstable, with broad basis and
a gait similarly unsure.
CT of the brain negative
Ultrasonography of extracranial cervical vessels inapparent
Lumbar puncture – under planning
Questions:
1. Which symptoms are dominant and what syndrome is here present?
2. What is the etiology of the disease?
3. Is the affection focal or multifocal?
4. What cerebrospinal fluid result would you expect?
5. Which other diseases can present a similar symptomatology?
6. Pathology: infectious encephalitides
7. Sleep disorders review