Case 24-2007: A 20-Year-Old Pregnant Woman with Altered Mental Status

A 20-year-old pregnant woman was admitted at 26 weeks' gestation because of dizziness, confusion, and difficulty walking. Six weeks earlier, she was confused and had odd head movements. Four days before admission, she had dizziness and weakness; she began to fall to her left and vomited. On admission, examination of the cerebrospinal fluid showed a lymphocytic pleocytosis with mildly elevated protein and normal glucose levels. During the next 18 days, her condition worsened. A 20-year-old pregnant woman was admitted at 26 weeks' gestation because of dizziness, confusion, and difficulty walking. On admission, examination of the cerebrospinal fluid showed lymphocytic pleocytosis. Presentation of Case A 20-year-old pregnant woman was admitted to this hospital at 26 weeks of gestation because of dizziness, confusion, and difficulty walking. Ten weeks before admission, the patient had a positive result on a home pregnancy test and presented to a neighborhood health center for prenatal screening. Tests for sickle cell trait, syphilis, and human immunodeficiency virus (HIV) and hepatitis B and C virus antibodies were negative. Serologic tests for varicella–zoster virus and rubella IgG were positive. Two weeks later, an endocervical specimen was positive for Chlamydia trachomatis infection and negative for gonorrhea. The patient missed follow-up appointments, . . .