Jas (Jazz)

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90 appearances 1 recordings 1 series first heard Jul 2026 last heard 31 Jul

Jas (Jazz)’s voice in public audio — every appearance, attributed to the second.

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Recordings per month over the last 12 months — 1 in all, peaking in Jul 2026 with 1.

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The Clinical Problem Solvers · Episode 469: SLS – Altered Mental Status · 31 Jul 2026 podcast

It's not the most easiest thing to do.

So moving on to the next piece of the clue in ALQA2 would be the focality of our symptoms.

So the right arm sensory loss, okay, with non-fluent speech tells me that this localizes to the left cerebral hemisphere.

And it cannot be explained by meningitis alone just because uncomplicated meningitis does not localize like that.

So now I'm concerned for intracranial complication.

And how can we connect that with meningitis?

You can have meningitis-associated cerebral infarctions, cerebritis, and abscess.

And in rare cases, even a cerebral venous sinus thrombosis.

So even though the initial CT scan, which it was non-conscious CT, was normal or did not show any abnormal findings, it could still be a little too early to exclude ischemia, meningitis, and early abscess formations.

So, in this situation, what I would do is immediate empiric treatment for bacterial meningoencephalitis, and that would include ceftriaxone and IV vancomycin.

And fun fact, vancomycin is usually added mostly for strep that is resistant to ceftriaxone.

along with dexamethasone.

And I'm going to defer to dexamethasone teaching to Makunt.

I know he's going to talk about it in a few seconds.

And I actually would also do intravenous acyclover here to make sure we're covering for herpes encephalitis, even though my suspicion right now is a little bit less likely.

Just as a side pearl, antibiotics in these situations should not be delayed for lumbar puncture or imaging.

It should be given first.

It does not obscure the LP findings in any way.

And because this patient is not really, she's comatose and has these focal deficits, I actually would favor repeating neuroimaging before getting a lumbar puncture.

But

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