This is a male patient, 22 years old, living in Medellin (Antioquia), with no relevant pathological or surgical history.
In the days prior to the onset of symptoms, she had traveled to the rural area of the department of Antioquia, which is characterized by dairy production, and her family reported a high consumption of unpasteurized dairy products.
The patient presented a clinical picture of 10 days of evolution, initially with headache of pulsatile characteristics, associated with nausea and vomiting on several occasions; in addition, photophobia and tinnitus.
After 48 hours of evolution, the patient presented pain in the lumbar region, with unquantified fever and profuse sweating, asthenia, adynamia and diplopia.
On the sixth day, an alteration in the state of consciousness began, becoming conscious sound, disoriented in space and time, and with visual impairments.
She was initially admitted to a basic health institution where a simple skull computed tomography (CT) was performed and obstructive hydrocephalia was observed, so specialized treatment was performed Neurological Institute of Colombia.
Upon admission to this institution on December 12, 2011, the patient was in poor condition, with a sound disorder, without pupillary opening, located painful stimuli, and presented bilateral exotropia, hyporeactive myotic alterations.
Systemic arterial hypertension, bradycardia, and respiratory compromise were found (quadrate), upon which he was intubated and it was decided to admit him to the neurological care unit.
Paraclinical examinations were performed at admission and the following imaging studies were performed: simple CT of the skull, which showed changes indicative of non-communicating hydrocephalia hydrocephalitis; single magnetic resonance imaging (MRI) with diffuse cervical spinal cord edema; and diffuse soft-sparietal spinal cord diffusion restriction of non-s
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For these findings an external ventricular shunt was performed for the management of non-communicating hydrocephalia and the collection of cerebrospinal fluid samples.
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On admission, empirical broad-spectrum antimicrobial treatment was initiated to cover Mycobacterium tuberculosis and the most common pathogens of bacterial meningitis and rhomboencephalitis; therefore, isoniazid, pyrazinamide, rifampicin, and phenytoin were formed.
Dexamethasone was added due to the extensive meningeal and medullary inflammatory involvement.
Antibiotic treatment was modified when cerebrospinal fluid culture was confirmed three days after admission, with negative results for other pathogens; only ampicillin and gentamicin was continued.
However, eight days after admission (20 December), he had greater neurological deterioration and was found to have ventilator-associated pneumonia, so meropenem was started.
Two days later (22 December) the patient showed mild clinical improvement: he was in command and mobilised all four limbs.
A new MRI was performed, which showed increased edema in the romboencephalon but no image that confirmed a brain abscess.
Hydrocephalia compression of the posterior fossa and herniation of the persistent obstructive sinus syndrome underwent a third ventricle-cisternostomy the following day, but this procedure failed.
After surgery, the patient again presented neurological deterioration with anisocoria and Glasgow scale of 4/15.
A simple CT scan of the skull showed hemorrhage in the third ventricle that compromised the brain stem and later died.
