Triple brain insults following cranial trauma.

Four days after cranial trauma, a 41-year-old man presented with fever, headache, confusion, and neck stiffness. He had received antibiotics in an outside hospital for these symptoms. There was no history of CSF rhinorrhea or otorrhea or chronic suppurative otitis media. He underwent cranial diffusion weighted MRI (Figures 1A & 1B), post contrast T1 weighted image (Figure 1C), apparent diffusion coefficient map (Figures 1D & 1E), and MRI venogram (Figure 1F). The CSF analysis showed 5960 cells with 80% neutrophils and 20% lymphocytes and elevated protein (400 mg/dl) and tested positive for Streptococcus pneumoniae antigen. Notice: Authors are encouraged to submit quizzes for possible publication in the Journal. These may be in any field of Clinical Neurosciences, and should approximately follow the format used here. Please address any submissions to the Assistant Editor, Neurosciences Journal, Riyadh Military Hospital, PO Box 7897, Riyadh 11159, Kingdom of Saudi Arabia. E-mail: [email protected]