CC: “I’ve had a horrible headache and stiff neck since yesterday and it’s getting worse”
Ms. E.J. is a 22 year old female who presents to the emergency department with complaints of worsening headache, nuchal rigidity, photophobia, fever and nausea and vomiting. Patient reports that her symptoms began yesterday with only a headache, neck stiffness, nausea and vomiting but she attributed them to potentially having a cold. Today she also endorses sensitivity to light and a low grade temperature.
Past Medical History
- Hypertension, age 20
Pertinent Family History
- Mother, age 47, (alive), thyroid disorder
- Father, age 50, (alive), hypertension
- Brother, age 20, (alive), well
Pertinent Social History
- College student, currently residing in the dormitory
Allergies
- None
Medications
- Lisinopril, 20 mg, po, QD
Vitals
- HR 91, BP: 162/74, T 102.1, RR 14, O2 99% RA
Testing
- Head CT: no abnormalities noted
- Lumbar puncture abnormal results: CSF cloudy, elevated WBC, elevated protein, decreased glucose
- C reactive protein: elevated
- Blood cultures: results pending
Focused exam
- HEENT: headache, photophobia, vision change denied. Reports neck stiffness.
- Neurosensory: positive Brudzinski”s and Kernig’s signs
- GI: Nausea and vomiting