A 43-year-old woman taking warfarin for past venous thrombosis presented with 4 days of flu-like symptoms and deterioration in level of consciousness. Computed tomography suggested subarachnoid haemorrhage, and magnetic resonance imaging showed widespread cerebral infarcts. However, these seemed out of proportion to the amount of haemorrhage, and lumbar puncture revealed meningitis caused by Streptococcus pneumoniae.
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We are grateful to the patient and her family for permission to publish this report. We also wish to acknowledge the clinical contributions of staff in the departments of neurosurgery, infectious diseases and neurology, and the intensive care unit of Canberra Hospital.