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An unusual “empty delta sign”
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  1. L Deus-Silva1,
  2. B Voetsch1,2,
  3. A Nucci1,
  4. J A Maciel1,
  5. L R Caplan3
  1. 1Department of Neurology, State University of Campinas, Campinas, Brazil
  2. 2Whitaker Cardiovascular Institute, Evans Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
  3. 3Department of Neurology, Division of Cerebrovascular Disease, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
  1. Correspondence to:
 Dr L Deus-Silva
 Departamento de Neurologia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Caixa Postal 6111, Cidade Universitána Zeferino Vaz, 13083-970 Campinas, São Paulo, Brazil

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A 34 year old man developed fever, right ear pain, and diffuse pulsatile headache 10 days prior to admission. Five days later he noticed difficulty in walking, instability, and intention tremor. Neurological examination showed a wide base gait, stance instability, slurred speech, bilateral horizontal nystagmus, intention tremor, four limb dysmetria, and dysdiadochokinesia. There were no signs of intracranial hypertension or cranial nerve dysfunction. Otoscopy revealed a hyperemic right tympanic membrane. Computerised tomography (CT) scan showed slow emptying of contrast in the left …

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