A 66 year old man presents with fever, a severe headache, photophobia, and nausea and vomiting for 3 days. The headache was acute in onset, severe, unremitting, and generalized. It was worsened by sudden movements, but not by coughing or sneezing. His medical and surgical histories are unremarkable, and he is not on any medications. A complete blood count is significant for a leukocyte count of 14,000/mm3, with 90% neutrophils. All other indices are normal.
The CT scan of the brain appears normal. There is no evidence of edema, hemorrhages, or mass lesions.
Opening pressure: 190 cmH2O (10-20) Appearance: Mildly cloudy WBC: 50/mm3 (0-5) Protein: 80 mg/dL (<45) Glucose: 20 mg/dL (50-80) Random Plasma Glucose: 110 mg/dL Gram stain: Gram-positive rods Culture reports will be available in 48 to 72 hours
Culture reports will be available in 48 to 72 hours
You realize that MRI imaging of the brain is not indicated right now.