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A 50-year-old Chinese woman reported a sharp paroxysmal headache and abrupt paralysis of the left leg. She then developed ptosis, blurred vision, diplopia and fever. On admission, a neurological examination revealed right III, IV, VI and left V1 cranial nerve palsy, bilateral upper eyelid oedema and left leg monoplegia (Medical Research Council grade 2/5). In addition, a left Babinski sign and nuchal rigidity were observed. Blood tests revealed elevated white cell count (WCC) and a majority of the cells were neutrophils. Lumbar puncture revealed that the WCC (120×106/μL) and protein level (0.79 g/L) of the cerebrospinal fluid (CSF) were slightly elevated, though the intracranial pressure was normal. A cranial MRI showed an infarction in the right corona radiata and base of the skull structures were also involved. MR arteriography indicated that multiple intracranial large arteries were narrowed Figure 1. Moreover, the CSF culture indicated Streptococcus anginosus infection, which was diagnostically very important. Accordingly, the patient was treated with vancomycin, tinidazole, low-molecular-weight heparin calcium and dexamethasone for 2 weeks. She …
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