Meeting Notes

Fri 21 Nov

A meeting was held on Fri about 3:30pm with about 20 in attendance from ICU attending, Infectious Disease, Neurology to brief Sue's family and colleagues on the current test results and next steps. Main next step is to do a 2nd spinal tap on Fri evening and continue with pending viral / bacterial tests.

ICU attending and resident staff will be rotating with replacements as early as Monday.


Steroid Treatment:
The Neurologist suggested steroid treatment as an option to reduce inflammation. At the end a question was asked about the timing for the decision to proceed. Neurologist wants to wait until comparing the initial results from the 2nd spinal tap to the first.

Attending ICU update:
History given, Spinal tap suggested a viral cause
Continue large infectious disease workup
Lumbar puncture fluid is all used, need 2nd
No tests have been positive
Ebv entra virus
No pateria in LP fliud
still pending: EEE, Cmv, West nile, Mycoplasma
Cmv viral lobe negative
MRI enhancement of the sinuses – could have been a bleed but could not be a
Abiotger KO

Neurologist update:
She was confused when entering icu
Large dose of mediations
Dilanton and sedation medicine aided to her confusion
Extensive infection still affecting both hemispheres (**NancyG.-Not sure what this means)
EEG monitored to ensure no more seizures
No clear seizures post entry into ICU
Need to monitor her for a long period of time
Periods of activiy not classic for activity
Repetive in nature
Propofol is keeping her calm on ventilator and strong anti-convulsive nature as well
On her scan abnormal
Extensive inflammatory response
Slow wave pattern in left temperal region (*Nancy – not sure what this means_


Infectious Disease: update:
High concern of infectious process going on
Bartinella virus – cat scratch fever ?
Routine bateria less likely
Listeria still an option
Leaning more toward encephalitis
CNS is primary
LCMV – what is that ?
Can’t test for hiv in Massachusetts without consent of patient (hippa rules)


Next steps from ICU:
Repeat lumbar test
Another test to establish a trend

Next steps from neurology:
1. Identify organisms
Take a broad approach
2. Keep her seizures under control
3. Review anti-steroid after review of spinal tap if looks more inflammatory