A 44 year old with a headache and signs of meningitis has an LP performed1. Three causes:
Infection – partially treated bacterial/ aseptic
Autoimmune/ Malignancy
SAH
based on CSF – likely to be viral meningitis
- Four Abnormalities:
Low Polymorphs/ high lymphocytes/ high protein/ normal glucose/ no bacteria indicates viral
Against viral is turbid CSF
Against SAH is reducing RCC in 3 samples almost down to 0
Malignancy/ autoimmune unlikely based on above, but must be kept in mind.
- Other tests:
CSF
- viral PCR/ nucleic acid detection test for HSV/ enterovirus/ VZV/ other (HIV/Cryptococcus etc)
- bacterial PCR/ nucleic acid detection test for Neisseria M/ Strep Pneumoniae
- India ink – cryptococcus
- Await culture
- Auto immune tests as indicated
Other
- bloods, including cultures if indicated
- CXR
- Urine
This patient developed shingles a couple of days later and her CSF had VZV