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A pregnant patient presented with neurological symptoms including headache, somnolence, and vision changes. Diagnostic tests revealed elevated cerebrospinal fluid pressure and lymphocytic pleocytosis, suggesting an inflammatory or infectious neurological condition.

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Area of Science:

  • Neurology
  • Obstetrics
  • Infectious Diseases

Background:

  • A 30-year-old pregnant patient (25 weeks) presented with a month of headache and two weeks of somnolence, photophobia, diplopia, and neck pain.
  • Initial presentation included papilledema and right abducens nerve palsy, with a normal head CT scan.
  • Pregnancy was uncomplicated, and the patient denied fever, recent travel, or relevant medical history.

Purpose of the Study:

  • To investigate the cause of progressive neurological symptoms in a pregnant patient.
  • To differentiate between infectious, inflammatory, and other neurological etiologies.

Main Methods:

  • Clinical examination, including cranial nerve assessment and fundoscopy.
  • Cranial CT and MRI of the brain.
  • Lumbar puncture for cerebrospinal fluid (CSF) analysis.
  • Extensive serologic and microbiologic testing.

Main Results:

  • Brain MRI revealed infratentorial and supratentorial abnormalities.
  • Lumbar puncture showed elevated CSF opening pressure (32 cm H2O) and lymphocytic pleocytosis (136 ×10^6/L total nucleated cells, 59% lymphocytes).
  • Extensive workup for infectious agents (including mycobacteria, viruses, and fungi) and autoimmune conditions was negative.

Conclusions:

  • The patient's presentation and diagnostic findings are suggestive of an inflammatory or infectious neurological process, despite negative specific testing.
  • Further investigation and management are warranted to determine the underlying cause and ensure maternal and fetal well-being.