CASE 49: HEADACHE AND CONFUSION
History
A 55-year-old man is admitted to hospital with headache and confusion. He has a cough
and a temperature of 38.2°C. He does not complain of any other symptoms. Two months
earlier he had been admitted with a productive cough and acid-fast bacilli had been found
in the sputum on direct smear. He had lost weight and complained of occasional night
sweats. He had a history of a head injury 10 years previously. He smoked 15 cigarettes a
day and drank 40–60 units of alcohol each week. He was found a place in a local hostel
for the homeless and sent out after 1 week in hospital on antituberculous treatment with
rifampicin, isoniazid, ethambutol and pyrazinamide together with pyridoxine. His chest
X-ray at the time was reported as showing probable infiltration in the right upper lobe.
Examination
He looked thin and unwell and he was slightly drowsy. His mini mental test score was
8/10. There were some crackles in the upper zones of the chest posteriorly. His respiratory
rate was 22/min. There were no neurological signs.
His chest X-ray is shown in Fig. 49.1.INVESTIGATIONS
Figure 49.1Chest X-ray.Question
- What might be the cause of his second admission?