A 48-year-old man was brought to our unit with deteriorating consciousness but no available history. His Glasgow Coma Scale score was 11/15 (E3, V4, M4). A limited neurological examination identified neck stiffness with normal upper and lower limbs except for extensor plantar responses. Cranial nerve examination was also limited, but with no obvious ophthalmoplegia, facial weakness, wasting of muscles of mastication or jaw drop. Following intubation, he was found to have persistently elevated inflammatory markers but negative blood and urine cultures. MR scan of brain with contrast showed multiple ring-enhancing lesions and meningeal enhancement without hydrocephalus (figure 1). Cerebrospinal fluid (CSF) analysis showed a raised protein, with lymphocytosis and low glucose. Nucleic acid amplification test of CSF for tuberculosis was positive. Figure 1 MR scan of brain showing multiple …

中文翻译：

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双侧三叉神经运动核综合征

一名 48 岁男子被带到我们的单位，他的意识不断恶化，但没有可用的病史。他的格拉斯哥昏迷量表评分为 11/15（E3、V4、M4）。有限的神经系统检查发现颈部僵硬，上肢和下肢正常，但伸足跖反应除外。颅神经检查也有限，但没有明显的眼肌麻痹、面部无力、咀嚼肌萎缩或下颌下垂。插管后，发现他的炎症标志物持续升高，但血和尿培养呈阴性。脑部 MR 增强扫描显示多处环形强化病灶和脑膜强化，无脑积水（图 1）。脑脊液 (CSF) 分析显示蛋白升高，伴有淋巴细胞增多和低血糖。脑脊液结核菌核酸扩增试验阳性。