intern_doc
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previously healthy 16 y/o come to ER 20min after episode of left arm shaking htat lasted approx 3 min. over past 2 days, he has fever and emotionalal lability. on arrival, temp 102 F, he is somnolent and disoriented to person,place, time. he responds poorly to pain. neuro exam show no abnormalities.
hem 34%
leuko 6000
seg neutro 50%
lympho 50%
platelet 280,000
analysis of CSF
leukocyte 120
seg neu 20%
lympho 80%
erythrocyte 300
glucose 60
protein 400
which likely cause of patient's neurologic finding
a. bacterial inf
b. congenita malformation
c. fungal inf
d. hemorrhage
e. immune mediated demylination
f. parasitic inf
g. viral inf
I pick D b/c of the CSF lab showed inc in erythrocytes, meaning bleeding froma AVM or something
But B is also correct if I am thinking AVM...
someone please explain...
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| mani
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i would choose G. i think its viral encephalitis
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| chemamr
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the findings of a CSF of a fungal infection are very similar to a viral infection. I think the CSF guides us to the diagnosis. The only thing that doesnīt fit too much is the increased number of RBCs in the CSF. itīs more common the viral infection (=aseptic meningitis).
So I would choose G, too.
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| drkpp
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what disaease one finds emotional lability?
i thougth its a feature of psedobulbar palsy, is it also found in viral men.?
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| intern_doc
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so u guys dont think it's AVM since erythrocyte count is 300 ? anyone
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| mani
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no i dont think it can be AVM. how will we explain wbcs then? rbcs can be present in csf in meningitis as well as encephalitis too, (in addition to SAH)
viral vs fungal: history is of acute illness, thats why i chose viral.
emotional lablity (as well as othe rcongnitive disturbances) can be found in encehpalitis
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| chemamr
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yes, the emotional lability can be caused by a meningitis or an encephalitis, itīs very inspecific.
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| bobby
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correct ans is G viral minigitis.
distintive future; confusione,disorientation + CSF lymphocytosis
the RBC maybe due to the inflamation caused by the organism
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