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.
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.
bloody - SAH
neck stiffness, kernig, brudzinski (thought all 3 not reliable)
obtundation: altered level of consiousness
stupor: near unconsiousness
fever itself cause headache
precipitate primary headache
abrupt onset. worst headache ever. occurs during exertion. coughing, strain, neck pain, nausea, vomiting, and transient LOC.
cervicocranial artery dissection
acute stokes, haemorrhage, ischaemia
cerebral venous sinus thrombosis
erythrocyte sedimentation rate.
temporal artery biopsy
contraindications to LP
herniation (due to raised ICP
loss of skin integrity
establish airway, oxygen, ventilation, circulation
blood samples. FBC. blood chemistry, culture.
glucose, thiamine, naloxone
cranial nerve involvement, hemiplegia, paraglegia
signs of meningitis or encephalitis present.