Case 52

 A seventy seven-year-old female came to our hospital for fever, vomiting and disorder of consciousness. She told us that she experienced a common cold with fever for several days before coming. She did not treat decayed tooth. At admission, left hemiparesis with positive left Babinsky sign and disorder of left-sided eye ball movement (probably left abducent nerve palsy) were found. Further, multiple red skin eruptions or petit hemorrhages were observed in upper and lower extremities, including red spot at the palm skin (Janeway lesion). Laboratory test revealed CRP 24.36 mg/dL, White blood cells 120100/mm³, Neutrophils 90.1%, LDH 415 U/L, AST 76 U/L ALT 58 U/L.
 Brain MRI was conducted for further examination.

Based on signs, symptoms and MRI findings, what is the appropriate clinical diagnosis ?

1. Metastatic tumors

2. Multiple brain microbleeds

3. Multiple hemangiomas

4. Septic embolism

5. Multiple sclerosis

answer

2017.4.26