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East and Central African Journal of Surgery

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Unusual Presentation of Meningitis following Stab Neck

NS Motsitsi

Abstract


Background: A case report of stab neck presenting at Kalafong Hospital, Pretoria, South Africa with atypical meningitis. The objective was to illustrate the challenge of diagnosing this unusual and late presentation of meningitis.
Case Report: A 48 year-old male patient presented to us two days after a stab neck. He was restless and inebriated. The neurological picture was that of Brown – Sequard syndrome. He was managed conservatively. He had two episodes of confusion and aggression. He only had one episode of temperature spike. There were no localizing signs. Brain scans were normal on both occasions. Cerebrospinal fluid analysis showed high neutrophils and lymphocytes. No bacteria were demonstrated by microscopy, culture or agglutinin tests. Tests and all investigations for tuberculosis were negative. HIV test was not done but the CD4 count was normal. He was started empirically on intravenous ceftriaxone. He regained consciousness within 24 hours. He improved dramatically and is undergoing rehabilitation at our centre.
Conclusion: Meningitis must always be borne in mind as a serious complication in a patient with stab neck. The clinical presentation may be unusual; the typical clinical features may be absent.



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