Results
The patient’s mental status started to improve over the next 24 hours;
he became more cooperative, started responding to commands, and was
successfully extubated. The neurological examination after extubating
which included cranial nerves, muscle strength and sensation, and tendon
reflexes were all unremarkable, although he still has neck stiffness and
limited hip flexion due to muscle pain. The patient remained slightly
confused and exhibited some degree of unusual behavior and language use
noticeable by his parents. He complained of some muscle aches and
headaches. The decision to discontinue antibiotics, acyclovir, and
dexamethasone was made after 4 complete days of treatment as the
etiology of his illness was likely from EBV infection.
His clinical and mental status gradually improved with supportive and
symptomatic treatment. By the fourth day of admission, his mental status
was back to normal baseline. He was able to walk around with minimal
muscle aches and a mild posterior headache. The patient continued to
exhibit no neurological deficit. Eventually, he was discharged home by
the seventh day.
Table 4: CSF Microbiology Panel