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Page 4 of 8 Dai et al. Neuroimmunol Neuroinflammation 2018;5:28 I http://dx.doi.org/10.20517/2347-8659.2018.09

Table 2. Comparison of the clinical characteristic and test results with the patient
Characteristics Day1 Day 3 Day 8 Day 14 Day 28
Clinical presentation
Consciousness Deliration Consciousness Consciousness Consciousness Consciousness
Neck rigidity Yes Yes No No No
Headache No No No No No
Fever No Yes Yes Yes Unknown
Score on Glasgow Coma Scale 13 13 15 15 15
Temperature (°C) 36.4 37.8 38.3 38.2 Unknown
CSF findings
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Leukocyte (× 10 /L) 74 640 384 Unknown 32
Protein level (mg/L) 6058 5160 2342 Unknown 359
CSF glucose (mmol/L) < 1.11 1.47 1.81 Unknown Unknown
Blood findings
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Leukocyte (× 10 /L) 12.1 19.16 21.89 11.25 11.16
Neutrophils (%) 87.9 81.2 87.2 75 79
Monocytes (%) 4 6.7 4.8 10.8 7.1
Lymphomonocyte (%) 7.7 12 6.7 11.9 11.9
Serum glucose (mmol/L) 8.33 10.95 6.83 6.61 Unknown
Cultures
Blood culture Negative Negative Negative Negative Unknown
CSF culture Positive Negative Negative Negative Negative
hs-CRP (mg/L) Unknown Unknown 57.04 34.03 25.3 (CRP)
Procalcitonin (ng/mL) Unknown 0.58 0.17 0.17 0.04
CSF: cerebrospinal fluid; hs-CRP: high-sensitivity C-reactive protein

waves as well as low amplitude of beta were observed in all leads. No sleep cycle wave was observed as well.

o
Day 3, he developed a mild fever with the temperature of 37.8 C. He became conscious but still cannot
communicate with the others. A lumbar puncture was performed to evaluate the effect of the therapy.
The WBCs in blood and CSF increased while the glucose and protein levels were improved [Table 2]. The
cultures of CSF and blood were negative.

Day 8, the physical examination showed the neck rigidity was better than before and there were few rales in
both lower lungs. Deep sputum cultures yielded multidrug-resistant baumanii and the amikacin (0.2 g ivd
q12h) was added.

As the neurological function was improved, we performed another lumbar puncture and the results showed
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the WBCs decreased to 384 × 10 /L and protein as well as the glucose increased to 2342 mg/L and 1.81 mmol/L
separately indicating the antibiotic therapy was effective. Controversially, the WBCs and hs-CRP in the
blood increased. Considering the symptoms and the results of CSF tests were both improved, the therapy
with meropenem and linezolid was continued.

While the treatment was effective based on the CSF results. We did the other tests to rule out the infection
of the other systems and the cacotrophy conditions. An echocardioram revealed no evidence of endocarditis
and colonoscopy revealed the ascending colon polyps and haemorrhoids. The chest X-ray found no tumor.
The abdominal CT scan was also negative.

The results of the marker for the systemic inflammation, CSF, clinical presentation are summarized in Table 2.
All together, meropenem (2 g ivd q8h) was given for 16 days, linezolid (0.6 g ivd q12h) was given for 15 days
and amikacin (0.2 g ivd q12h) was given for 5 days. Other treatments including nutritional supporting, early
rehabilitation, bronchofiberscope, bed sore prevention were also given to the patients. Finally, the patient was
completely awake and transferred to the rehabilitation facility.