what was the nature of these stab wounds?? "shanks", or homemade knives
common in prison (in South Africa the Tsotsis, gangs, use bicycle spokes
that are shrapened) can make very deep, small holes and that could lead to
what Darrell proposes.
saw a lot of these injuries where i went to med school, we had 4 maximum
security prisons, and they can be VERY hard to find and cause lots of
damage...the guys using them are pretty "good" at what they do!
On Tue, Jun 26, 2012 at 1:05 AM, Darrell Looney <[log in to unmask]> wrote:
> Seeding of the CSF via penetrating trauma was my first thought.
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> > Date: Mon, 25 Jun 2012 12:13:30 -0700
> > From: [log in to unmask]
> > Subject: advice please
> > To: [log in to unmask]
> > Strange case leaves me with questions.
> > 15 yo male arrived with severe ha and and pain. pt had been
> "stabbed" x12 with unknown instrument (the first doctor told him it looked
> like a box cutter did it) on back of neck,back and post chest 8 days prior.
> wounds were all similar and about 3 cm and stapled shut by other hospital.
> apparently cxr was neg. pt did fairly well till 3days pat when above sx
> began. one vomit episode. min photophobia complained by pt but not seen on
> exam. rigidity of neck difficult to evaluate due to the stapled wounds. no
> fever x 2 here. neuro intact and pt alert if a bit whiny. abdomen mod
> tender diffusely except for rlq. no guarding rigidity
> > i got a ct of head and abd. no bleed or injury noted in head and abd neg
> x a small rt ptx.
> > pt with normal bp and pulse and temp
> > wbc was 20k. chem 7 and ua tox neg.
> > Lp was cloudy and had 2700 abc and 3000 rbc and neg gram stain. normal
> csf glucose and high protein culture neg x 2 days now.
> > I began antibiotics upon seeing the spinal fluid drip out.(pressure not
> measured but it was certainly not high)
> > pt admitted to the pedi hospitalist
> > my question is could the meningitis be due to a "stab" of the neck?
> also, if the culture grows nothing after 2 days do you stop antibiotics?
> the blood cx was neg. the antibiotics were given right after the LP
> performed. Hsv pcr is pending. I did not do a west nile.
> > thanx
> > don
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