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23-year-old male medical student complains of a headache and intermittent…
23-year-old male medical student complains of a headache and intermittent fever for 2 weeks.
Infection
intracranial
meningitis
bacterial: WBC >2000/ul. neutrophil >1180/ul. CSF to blood glucose level <0.23. glucose <1.9mmol. protein >2.2g/L
normal CSF -> proceed to do 2nd LP after 12-24 hours.
encephalitis
parameningeal infections
systemic
Tests
CSF
bloody - SAH
PE
neck stiffness, kernig, brudzinski (thought all 3 not reliable)
obtundation: altered level of consiousness
stupor: near unconsiousness
neuroimaging
non infective
extranial noninfective
immunological
temporal arteritis
erythrocyte sedimentation rate.
temporal artery biopsy
intracranial noninfective
cervicocranial artery dissection
acute stokes, haemorrhage, ischaemia
cerebral venous sinus thrombosis
mass lesion
subarachnoid haemorrhage
abrupt onset. worst headache ever. occurs during exertion. coughing, strain, neck pain, nausea, vomiting, and transient LOC.
fever itself cause headache
precipitate primary headache
migraine
tension headache
cluster headache
contraindications to LP
cardiorespi failure
herniation (due to raised ICP
bleeding disorders
loss of skin integrity
management
establish airway, oxygen, ventilation, circulation
blood samples. FBC. blood chemistry, culture.
glucose, thiamine, naloxone
focal symptoms
cranial nerve involvement, hemiplegia, paraglegia
signs of meningitis or encephalitis present.
HSV encephalitis
Ataxia
GBS?