sandra
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9. A previously healthy 16-year-old boy is brought to the emergency department 20 minutes after
an episode of left arm shaking that lasted approximately 3 minutes. Over the past 2 days, he has
had fever and emotional lability. On arrival, his temperature is 38.9 C (102 F). He is somnolent and
disoriented to person, place, and time. He responds poorly to pain. Neurologic examination shows
no other abnormalities. Laboratory studies show:
Hematocrit 34%
Leukocyte count 6000/mm3
Segmented neutrophils 50%
Lymphocytes 50%
Platelet count 280,000/mm3
Analysis of cerebrospinal fluid shows:
Leukocyte count 120/mm3
Segmented neutrophils 20%
Lymphocytes 80%
Erythrocyte count 300/mm3
Glucose 60 mg/dL
Protein 400 mg/dL
Which of the following is the most likely cause of this patient's neurologic findings?
A
) Bacterial infection
B
) Congenital malformation
C
) Fungal infection
D
) Hemorrhage
E
) Immune-mediated demyelination
F
) Parasitic infection
G
) Viral infection
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g herpes ence
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