BOF: 94
A 38 year old male presents with a
history of dull headache of a few weeks duration. In addition he had felt
generally unwell with mild fever and lack of appetite. No past illnesses of
note, he was not on any drugs.
On examination you note that he is
ataxic and there is a sixth nerve palsy on the right side.
He has a CT scan show meningeal
enhancement and dilated ventricles
CSF
Opening pressure 300 mm H2O
Protein 2.2 g/L
Cells 60 /mL (90% lymphocytes)
Glucose 0.5 mmol/L
Blood
Hb 13.5 g/dL
WBC 11 x109/L
Glucose 6.0 mmol/L
After microbiological evaluation of
the CSF the patient is commenced on appropriate antimicrobial agents. However,
a few days after this the patient’s level of consciousness begins to
deteriorate.
Blood tests show
Sodium 134 mmol/L
Potassium 3.8 mmol/L
Urea 7.0 mmol/L
In this situation your next step would
be to use:
a)
Steroids
b)
Mannitol
c)
Fluid restriction
d)
Streptomycin
e)
Hypertonic saline
