An 18-year-old man reached a hospital in eastern India in a sickle cell pain crisis, running a fever with a cough and a headache that had been building for two days. A soft, boggy swelling covered both sides of his forehead. He was fully alert. He went home ten days later on transfusion, antibiotics and painkillers.
A 15-year-old girl reached a hospital in the same region with back pain, chest pain and aching thighs. On day four she began vomiting and seeing double. Within hours of a bedside examination, her Glasgow Coma Scale score dropped from 13 to 7, and surgeons were opening her skull to evacuate a clot estimated at 180 milliliters.
