ARJ
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A previously healthy 16-year-old boy is brought to the emergency department 20 minutes after an episode of left arm shaking that lasted approximately 3 minutes. Over the past 2 days, he has had fever and emotional lability. On arrival, his temperature is 38.9 C (102 F). He is somnolent and disoriented to person, place, and time. He responds poorly to pain. Neurologic examination shows no other abnormalities. Laboratory studies show:
Hematocrit 34%
Leukocyte count 6000/mm3
Segmented neutrophils 50%
Lymphocytes 50%
Platelet count 280,000/mm3
Analysis of cerebrospinal fluid shows:
Leukocyte count 120/mm3
Segmented neutrophils 20%
Lymphocytes 80%
Erythrocyte count 300/mm3
Glucose 60 mg/dL
Protein 400 mg/dL
Which of the following is the most likely cause of this patient's neurologic findings?
A Bacterial infection
B Congenital malformation
C Fungal infection
D Hemorrhage
E Immune-mediated demyelination
F Parasitic infection
G Viral infection
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| mani
Forum Guru
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G Viral infection
clinical features suggest encephalitis and CSF analysis suggests that it may be viral or fungal. I have chosen viral as viral encephalitis is more common than fungal, history is of short duration, and there is no hint to immune suppression in the scenario
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| phuluong2k
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Viral too, but there is so much RBC in CSF ?
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| nisha
lil monkey
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Well HSV is notorious for RBC's in CSF
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| ARJ
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"Live as if you were to die tomorrow. Learn as if you were to live forever." --Mahatma Gandhi
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| mani
Forum Guru
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we can have rbcs in CSF in any form of encephalitis
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| kabu
Forum Senior
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G?
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