Surgical Pathological Conference Infective Endocarditis with Brain Abscesses

Surgical Pathological Conference Infective Endocarditis with Brain Abscesses (2006 -05 -25) 神經內科 洪國華

General Data • • Name: 金 X X Age: 50 y/o Marital Status: Married Gender: Male Tribe: Paiwan Chart Number: 74045442 Date of Admission: 2006 -02 -24 Date of Discharge: 2006 -03 -24

Clinical Course • 2006 -01 -26 • • 2006 -01 -30 2006 -02 -? ? 2006 -02 -23 Called at Taitung Hospital with low back pain Intubated ICU B/C: MRSA Right hemiplegia Brain CT: Brain abscess Transferred to MMH-TT

MER on 2006 -02 -23 • GCS=E 4 M 5 VE • T 36. 4 o. C P 105 R 20 BP 136/87 • p. H=7. 49 PCO 2=43. 5 PO 2=82. 0 HCO 3=33. 1 • Hb=10. 4 WBC=10400 (N/M/L=57/9/29) Plt=515000 • Glu=138 BUN/Cr=14/0. 6 Na/K=137/3. 2 • PT INR=1. 14 a. PTT=35. 3 (control=32. 4)

Clinical Course • 2006 -02 -24 • 2006 -02 -25 Brain CT Removal of brain tumor Extraventricular drainage Culture of abscess: MRSA Culture of blood: No growth x II Cardiac echo: MV vegetation with moderate-to-severe MR

Pre-contrast CT scan of brain on 2006 -02 -24

Post-contrast CT scan of brain on 2006 -02 -24 Back to 2006 -02 -24

Diagnosis • Infective endocarditis, with moderate-tosevere mitral regurgitation and multiple brain abscesses, MRSA

Treatment • Vancomycin 1 gm IVD Q 12 h • Claforan 2 gm IVD Q 4 h • Extraventricular drainage +/- surgical removal of brain abscess

Clinical course • 2006 -03 -25 ~ 2006 -03 -1 • 2006 -03 -02 (W 5) • 2006 -03 -04 (W 7) Afebrile GCS=8~10 Rt hemiplegia Normal BP HR around 100 T=38. 5 o. C GCS=7~10 GCS=5~6

Pre-contrast CT scan of brain on 2006 -03 -06

Post-contrast CT scan of brain on 2006 -03 -06

Clinical Course • 2006 -03 -06 ~ 2006 -03 -20 • 2006 -03 -20 • 2006 -03 -21 • 2006 -03 -22 • 2006 -03 -24 Fever off and on Quadriplegia GCS=4~5 WBC=7600 Hb=11. 0 BUN/Cr=12/0. 6 Na/K=144/3. 6 Brain CT Hypotension Passed away

Pre-contrast CT scan of brain on 2006 -03 -21

Post-contrast CT scan of brain on 2006 -03 -21

Diagnosis • Infective endocarditis, with moderate-tosevere mitral regurgitation and multiple brain abscesses, MRSA