{"ops":[{"insert":"An 81 year old man presents with fever, chills, rigors and myalgia for 3 days. He also complains of tremors in his hands, weakness of his lower limbs, and difficulty in walking for the same duration.\n\nHis family members noted progressive changes in his behaviour since a day ago. He had gone camping in South Dakota 2 weeks prior to the onset of these symptoms.\n\nHis medical history is significant for diabetes, atrial flutter and sick sinus syndrome for 30 years, with pacemaker implantation.\n\nHe drinks socially, is not on any recreational drugs, and is not sexually promiscuous.\n"},{"insert":"\n"},{"insert":{"image":"\/storage\/case-images\/pd\/PD-M-056_en.png"}},{"insert":"\n"}]}
2
Investigate
Lumbar Puncture
{"ops":[{"insert":"Appearance: clear\nWBC: 24\/mm3 (0-5)\n Neutrophils: 81%\nProtein: 68 mg\/dL (18-58)\nGlucose: 64 mg\/dL (50-80)\nGram stain: negative; preliminary culture reports will be available in 24 hours.\nBlood sent for CSF tests for varicella, herpes, syphilis, Epstein-Barr virus, Cytomegalovirus, and Cryptococcal antigens. Results pending.\n"}]}
MRI Spine & Brain
{"ops":[{"insert":"You recall that a cardiac pacemaker has been implanted in this patient, and realize that MRI is contraindicated.\n"}]}
