Question 166 · LEK · Meningitis

A 53-year-old female patient was admitted to the hospital because of headache worsening for the last few days, fever (38.8 Celsius), nausea. On examination: lethargy and drowsiness, nuchal rigidity 3 fingers, Kernig’s sign present. Cerebrospinal fluid (CSF) testing: cloudy, opalescent, protein level 220 mg/dL (0.22 g/L), cytosis 390 white cells per mm³ (granulocytes 70%), glucose level 40 mg/dL (2.2 mmol/L). Serum glucose level 100 mg/dL (5.55 mmol/L). Which of the following should be done during the first 24-hour in-hospital stay?

1. AA. order bacteriological examination of the cerebrospinal fluid (CSF) and immediately start empirical wide-spectrum, intravenous antibiotic at a maximum dose (e.g. 3rd generation cephalosporin).
2. BB. order bacteriological examination of the cerebrospinal fluid (CSF), but due to the lack of information about the etiological factor and stable condition of the patient start antipyretic (paracetamol - acetaminophen) and antioedematous (mannitol) treatment till you get the CSF culture result and antibiogram.
3. CC. order neuroimaging of the head with computed tomography or magnetic resonance technique and decide about treatment after you get the report.
4. DD. start antiviral drug intravenously (optimally acyclovir) at a maximum dose, because the result of CSF testing indicates viral meningitis.
5. EE. order digital angiography because the clinical situation described above may suggest subarachnoid hemorrhage.