Case 66

 A ninety nine-year-old male was admitted to our hospital for weakness of extremities and speaking disturbance which occurred twenty two days ago. MRI showed no evidence of brain ischemic damage but relatively loss of brain volume at that time. Thereafter, he was given drip infusion and his condition was gradually improving, being scheduled to discharge. However, immediately before discharge, he experienced diarrhea, sputum and fever. His consciousnes altered and became unclear. His constructive blood pressure retained to be low (139 to 100 mmHg). Chest CT showed pleural effusion and pneumonia. Laboratory test revealed CRP of 7.56 mg/dL, white blood cells 9320/mm³, neutorophils 87.5 %. He was given drip infusion of antibiotics. Brain CT was conducted for consciousness disorder.

What is your diagnosis ?

1. Brain infarction

2. Brain abscess

3. Septic emboli

4. Posterior reversible encephalopathy syndrome (PRES)

answer

2017.8.9