Laboratory studies, including urinalysis, are normal. The results of a lumbar puncture are pending. This man most likely has St. Louis encephalitis, an arthropod-borne illness whose vector is the Culex mosquito, prevalent in the Western and Central U.S. during the months of June through October. The presence of the Gateway Arch, a national landmark located in St. Louis, MO, on the forehead of a patient with headache, fever, and confusion is pathognomonic for St. Louis Encephalitis. St. Louis Encephalitis differs from other conditions in which an arch appears on a patient's forehead by the presence of a large riverboat near the arch, as seen in the close-up above.
Treatment involves supportive care, and frequent wiping of the forehead with hydrogen peroxide.
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