On arrival, she had a temperature of 41.0°C, a heart rate of 118 beats/min, and blood pressure of 148/81 mm Hg. She was intubated and minimally responsive. Neurological examination revealed a left sixth cranial nerve palsy, paralysis of the right upper extremity, 3+ deep tendon reflexes, and bilateral Babinski signs. The left eye was chemotic but not proptotic. The remainder of the examination was notable for nuchal rigidity and bilateral pulmonary crackles. Treatment with vancomycin hydrochloride, ceftriaxone, and acyclovir was started. Laboratory studies revealed that her white blood cell (WBC) count was 13100/μL; erythrocyte sedimentation rate, 84 mm/h; and C-reactive protein level higher than 100 mg/L. Cerebrospinal fluid (CSF) examination revealed a leukocyte count of 266/μL (96% segmented neutrophils); protein level, 249 mg/dL; lactate level, 39.64 mg/dL; and a glucose level within reference range. (To convert WBC count to times 109 per liter, multiply by 0.001; to convert C-reactive protein to nanomoles per liter, multiply by 9.524; to convert lactate to millimoles per liter, multiply by 0.111.) Magnetic resonance imaging and venography of the patient's head demonstrated thrombosis of the anterior and mid-superior sagittal sinus, multiple venous infarcts, prominent leptomeningeal enhancement, and a left subdural fluid collection (Figure 2). Blood cultures taken at the time of admission yielded MRSA, and therapy was adjusted to vancomycin, rifampin, and heparin sodium. Vancomycin trough concentrations were maintained at 20 to 25 μg/mL. The patient underwent emergency decompressive bifrontal craniectomy with debridement of epidural and subdural intracerebral empyemas. Purulent fluid was also evacuated from the subgaleal space. Cultures of the CSF, dura, skull, and thrombosed sagittal sinus all yielded MRSA. Unfortunately, the patient remained neurologically devastated despite decompressive surgery, and follow-up imaging showed the development of frontal lobe intraparenchymal abscesses, multiple septic pulmonary emboli, and evolving bihemispheric strokes. The family decided to focus her care on comfort measures only, and she died on hospital day 23. Autopsy findings confirmed bilateral frontal lobe infarctions and abscesses, extensive meningitis, superior sagittal sinus thrombosis, and diffuse bronchopneumonia with abscess formation.