Skip to main content
. Author manuscript; available in PMC: 2018 Jun 1.
Published in final edited form as: J Clin Pharm Ther. 2017 Mar 29;42(3):350–355. doi: 10.1111/jcpt.12520

Table 1.

Clinical course of neurotoxicity and patient covariates at our facility

Date Mental status Imaging Laboratory and microbiology findings SCr (mg/dL) CrCl (Cockcroft-Gault) (mL/min)
Hospital day 0 Oriented to person, city, but not oriented to date, state or situation. CT brain
XR chest
Renal ultrasonography
-Skin herpes simplex and VZV DFA negative
-Rapid shell viral culture negative for herpes simplex and VZV
-Urinalysis: Specific gravity 1.017, protein screen positive, glucose screen negative, no ketones, trace blood, 2–5 granular casts, >10 hyaline casts, 0 WBC, 0 RBC
-Urine culture: 2,000 cfu/ml Gram Negative Rods
2.54 26.44
Hospital day 1 Fluctuating mental status CT spine
MR brain
2.52 26.65
Hospital day 2 Somnolent, slightly more confused. After a few attempts was able to give his own name. Not oriented to location.
Followed some commands but resisted exam.
EEG Blood cultures: MSSA 2.42 27.75
Hospital day 3 Inappropriate reactions (e.g. hiding under bedsheets) CT abdomen, chest, pelvis 2.36 28.46
Hospital day 4 Alert and oriented × 0–1 to self. Mental status and ability to follow commands progressively declining -Skin Herpes simplex and VZV DFA negative
-Rapid shell viral culture negative for herpes simplex and VZV
2.35 28.58
Hospital day 5 Disoriented, flat affect, non-verbal, minimally responsive to vocal cues, responsive to painful stimuli and loud voice only. CSF cell count with differential: 37 WBC (83% lymphocytes, 15% monocytes, 1% macrophages, 1% neutrophils); 4 RBC
CSF glucose: 90
CSF gram stain and culture: gram stain negative, culture with no growth at 72 hours
CSF protein: 72
CSF VZV PCR: 912 copies/mL
Blood glucose: 146
2.36 28.46
Hospital day 6 Non-verbal, somnolent MRA head
MR spine
2.51 26.76
Hospital day 7 Awake and interactive, follows commands and responding to verbal cues, albeit mostly with inappropriate responses.
Notes earlier hallucinations and red vision (“only seeing things in red”)
2.41 27.87
Hospital day 8 Fully alert and oriented this morning, more interactive 2.21 30.39
Hospital day 9 Patient is fully oriented, alert and communicative Transesophageal echocardiography 1.99 33.75
Hospital day 10 Alert and oriented, more confluent speech with less word finding 1.96 34.27
**

All CTs and MRs were done without contrast dye. All creatinine clearances calculated using weight of 62kg.

Abbreviations: CSF: cerebral spinal fluid; DFA: direct fluorescent antibody; Echo: Echocardiogram; EEG: Electroencephalography; MR: Magnetic Resonance; MSSA: methicillin-sensitive Staphylococcus aureus; PCR: polymerase chain reaction; RBC: red blood cells; VZV: Varicella zoster virus; WBC: White blood cells; XR: X-Ray