31-year-old obese woman, usual cocaine and base paste.
The disease begins with headache and vomiting, sequentially motor difficulty of the right limbs and dysarthria, confusional state and inventable sleepiness.
After three weeks of onset, the disease was admitted to reactive coma, locating aphthalmetic stimuli, without meningeal signs, isochoric with reactive pupils, right hemiparesis, right reflex
Normal eye fund.
No other findings in the general examination.
Brain CT scan with multiple white substantia hypodense images.
Blood count, cerebrospinal fluid, creatinine, glycemia, prothrombin and normal plasma electrolytes.
Antinuclear antibodies and ANCA were negative for HIV.
Electroencephalogram shows symmetric slow activity.
Two days later, she presented fever due to pneumonia radiologically confirmed.
Brain MRI (FLAIR, T2) showed bilateral hyperintense images of the white brainstem, cerebellum and brainstem.
Boluses of 1 g of methylprednisolone were initiated.
Greater reactivity was observed, two days later a second bolus was applied.
You have a fever attack at 39°C, and fall into deep coma.
The patient died the next day and a medico-legal autopsy was performed.
