On central nerve examination, GCS=10/15, moving all limbs, neck stiffness, meningeal sign
(9) have reported a 59% polymerase chain reaction positivity in the CSF examination of 39 patients with leptospirosis with meningeal signs
were absent, and deep sensation was intact.
However, the frequency of positive meningeal signs
was significantly higher in those with CNS infection.
There were no meningeal signs
or focal neurologic deficits.
described a case of LNB where the first manifestation of the disease was a cerebral ischemic stroke, nonspecific systemic signs (malaise, headache, and amnestic cognitive impairment), meningeal signs
, and a tick bite 4 weeks prior.
Neurological examination did not show any focal deficits and she had no meningeal signs
or neck stiffness.
One case had cerebellar symptoms such as ataxia and dysdiadochokinesia (9); in another case the alteration of the state of consciousness was one of the first symptoms (10), and in another no meningeal signs
were reported (11).
Mimics include neuroleptic malignant syndrome, malignant hyperthermia, thyroid storm, drug fever, hypothalamic brain stem stroke, heat prostration, cancer, trauma, pancreatitis, seizures, CNS infection, and endocarditis.[sup] In this case, the patient was febrile and not sedated; there were no focal signs, no meningeal signs
, no trauma, whereas Confusion Assessment Method indicated delirium, therefore SAE was likely.
Neurological examination showed no focal or meningeal signs
. Laboratory tests revealed thrombocytopenia (85000/uL) and a significant increase in leukocytes (16860/uL), neutrophils (15800/uL), C-reactive protein (18.1 mg/dL), blood urea nitrogen (93mg/dL), and creatinine (2.8 mg/dL).
His fever subsided, and the headache and meningeal signs
Myoclonus, tremors, paresis, torticollis, nystagmus, meningeal signs
of hyperesthesia and cervical rigidity or optic nerve signs may also be seen (Mc Grath,1960; Innes and Saunders ,1962).