A 5-year-old girl presented with intermittent high-grade fever for a month that became continuous over last 5 days. She also experienced epistaxis from the right nostril for 15 days, polyuria for 10 days, and impaired consciousness for a day prior to the admission. There was no history of seizures, headache, vomiting, bleeding from any other mucosal site, or trauma.
On examination, the modified Glasgow coma scale (GCS) score was 3, there was bilateral bluish discoloration of lids and eyes, papilledema and unequal pupils, both reacting to light. Investigations Hemoglobin 5.8 g/dL Platelet count: 82000/μL Leukocyte count total: 4800/μL Differential P-60, L–35, M-3, E-2 Prothrombin time: Normal Serum sodium: 140 mEq/L Potassium: 1.6 mEq/L Urea: 21 mg/dL Creatinine 0.9 mg/dL Blood sugar: 577 mg/dL pH: 6.9 Bicarbonate: 6 Noncontrast computerized tomography of head: Extensive infarct in…
