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08/08/2011 - Mollaret's meningitis

posted Sep 20, 2011, 7:56 AM by Chief Resident   [ updated Sep 20, 2011, 7:57 AM by Purnema Madahar ]
We're entering the second week without any major mishaps over the weekend. Some glitches were brought to my attention, and I will do my best to fix those.
 
As usual, a few general remarks:
 
1. Taxi vouchers - with the new change to the overnight intern's schedule, taxi vouchers are only to be used in two instances:
a. when on overnight call on Saturday, which starts at midnight; you can use the voucher from anywhere in the city to Moses or Weiler. Make sure to pick up a voucher in advance and to book the car several hours before you need it.
b. when traveling between Monte housing (at Moses or in Riverdale) and Weiler during hours the shuttle doesn't operate.
Although you might travel at odd hours when on call or otherwise, the program cannot provide taxi vouchers for those situations.
 
2. Jeff Ceresnak asked me to pass on the following comments from his meeting with SW and nursing:
- All patients on all units/floors need to be discussed at SW rounds, even if there is no change in status. And this includes special care/HIV patients as well.
-Dc summaries/scripts/face to face/etc need to be done ASAP, often the day before a discharge in order to reinstate services.
-Don't forget to talk to the nurses for critical issues rather than just putting in orders (ie isolation/contact/etc).
-At the end of the day or when coming in, don't forget to sign into the system -- someone needs to be responsive 24/7.
 
On to more educational grounds:
 
Lauren Shapiro read this in the New York Times Magazine this weekend - sounds familiar? 
 
At this morning's IMR, Christina Cruz presented the case of a gentleman with aseptic meningitis to Jerry Paccione. Of the many teaching points he made, I'll only pass on the Zebra:
 
Mollaret meningitis, or recurrent benign lymphocytic meningitis (RBLM, so much more descriptive than an eponym) is a rare, recurrent meningitis, most often associated with HSV 2. The attached CID paper reviews three case series. Strictly speaking, Mollaret meningitis is different from RBLM in that the CSF shows an initial polymorphonuclear predominance followed by lymphocytic predominance. However, as Jerry mentioned and the paper confirms, this transient poly predominance can be seen in many viral CNS infections. Of note, Mollaret meningitis has also been associated with epidermoid cysts in the CNS.
 
I'm taking the boards tomorrow. Joe and Lauren will be around, don't hesitate to page or call them with questions you would normally ask me. 

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