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 (normal: 4,600-11,000) with 90% neutrophils. C-reactive protein is 60 ng/mL (normal: <6)
The CT scan of the brain appears normal. There is no evidence of edema, hemorrhages, or mass lesions.
Opening pressure: 19 cmH2O (10-20) Appearance: mildly cloudy WBC: 50/mm3 (0-5) Protein: 80 mg/dL (<45) Glucose: 20 mg/dL (50-80) Gram stain: gram-positive rods A random plasma glucose obtained simultaneously is 110 mg/dL. CSF samples are sent for culture and polymerase chain reaction (PCR). Reports will be available in 48 to 72 hours.
Samples are sent for culture and polymerase chain reaction (PCR). Reports will be available in 48 to 72 hours.
You realize that MRI imaging of the brain is not indicated right now.