Case-Based Modules > Case 4 > Stage 4

Sorry! Try to think again about the overall picture: this is an immunosuppressed patient who has now had episodes of obtundation and bilateral fixed and dilated pupils. There hasn't been any evident large structural abnormality that would cause this. You've thought about whether something could be affecting cranial nerve function via infiltration. Her CSF was definitely abnormal and suggests an atypical infection, like something fungal. What else could this process-- of leptomeningeal spread-- do from a physiologic standpoint to the brain that could also cause episodic signs/symptoms? Something about pressure maybe?

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