Monicah is a 17 year-old woman brought to the clinic by her husband.

Right-sided weakness and confusion. Previously healthy according to the husband. No recent cough, dyspnea or diarrhea. Poor appetite, easily fatigued for several months. Complained of 'hotness of body' recently. Had been treated for malaria and typhoid without improvement of her symptoms.

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Physical exam:

• Confused and unable to give her history, appears sick and is very thin.
• Vital signs: Temp = 38°C, Pulse = 120, BP = 100/60, Resp = 22
• Right pupil is slightly dilated and there is a left ptosis. Other CN appear intact.
• Neck is stiff, however, there is no JVD nor cervical adenopathy.
• Lungs are clear, but breathing is shallow. No abnormal heart sounds.
• Abdomen is soft and there are no masses.
• Right-sided weakness, upper extremity more so than the lower.
• Blood smear is negative for paraites.

An LP is done, a hemogram and ELIZA for HIV are ordered.

• She is admitted and started on Chloramphenicol, quinine and Fansidar.

The following morning on rounds.