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Jason R. Boole, MD; Mitchell Ramsey, MD; Gregory Petermann, MD; Joseph Sniezek, MD
Tripler Army Medical Center, Honolulu, Hawaii

Arch Otolaryngol Head Neck Surg. 2003;129:1247.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

A 46-YEAR-OLD man presented with a 1-year history of a severe progressive headache and neck stiffness. He complained of fever but denied nausea or vomiting. His medical history was significant for 20 years of alcohol abuse and a previous elevation in serum bilirubin levels. His temperature was 38.3°C; heart rate, 99 beats/min; and blood pressure, 126/75 mm Hg. He was awake and oriented to person, place, time, and situation but demonstrated slow mentation. His physical examination was remarkable for rigidity and tenderness in the lateral aspect of the left side of his neck. There was no evidence of masses, lymphadenopathy, or edema. Right-sided torticollis and a mild amount of trismus were also observed. A bulging posterior nasopharynx was noted on fiberoptic examination. The findings of cranial nerve examination were normal. The white blood cell count was 13 800 . . . [Full Text of this Article]

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