Clinical Reasoning: A 64-Year-Old Man With Confusion, Nausea, Seizure, and Fever.

IF 7.7 1区医学 Q1 CLINICAL NEUROLOGY

Neurology Pub Date : 2025-07-01 Epub Date: 2025-06-06 DOI:10.1212/WNL.0000000000213659

Zhimin Xu, Subhan Khan, Ahya Ali, Terry Park, Fang Yu, Jon Rosenberg, Fawaz Al-Mufti

引用次数: 0

Abstract

Evaluating patients with encephalitis is common, but it can be complicated in immunocompromised patients. In this case, a 64-year-old man with a medical history of multiple myeloma and previous Lyme disease presented with acute onset of confusion, nausea, and fever; developed generalized tonic-clonic seizures; and subsequently became comatose. This case highlights the importance of thinking broadly beyond common viral and bacterial encephalitides and developing a comprehensive differential diagnosis.

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临床理由：64岁男性，精神错乱，恶心，癫痫发作，发烧。

评估脑炎患者是常见的，但在免疫功能低下的患者中可能会很复杂。在本病例中，一名64岁男性，有多发性骨髓瘤病史和既往莱姆病，表现为急性发作的精神错乱、恶心和发烧；发生全身性强直阵挛性发作；然后就昏迷了。这个病例强调了广泛思考的重要性，超越了常见的病毒性和细菌性脑炎，并制定了全面的鉴别诊断。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Neurology 医学-临床神经学

CiteScore

12.20

自引率

4.00%

发文量

1973

审稿时长

2-3 weeks

期刊介绍： Neurology, the official journal of the American Academy of Neurology, aspires to be the premier peer-reviewed journal for clinical neurology research. Its mission is to publish exceptional peer-reviewed original research articles, editorials, and reviews to improve patient care, education, clinical research, and professionalism in neurology. As the leading clinical neurology journal worldwide, Neurology targets physicians specializing in nervous system diseases and conditions. It aims to advance the field by presenting new basic and clinical research that influences neurological practice. The journal is a leading source of cutting-edge, peer-reviewed information for the neurology community worldwide. Editorial content includes Research, Clinical/Scientific Notes, Views, Historical Neurology, NeuroImages, Humanities, Letters, and position papers from the American Academy of Neurology. The online version is considered the definitive version, encompassing all available content. Neurology is indexed in prestigious databases such as MEDLINE/PubMed, Embase, Scopus, Biological Abstracts®, PsycINFO®, Current Contents®, Web of Science®, CrossRef, and Google Scholar.