suv
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??
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| robin082006
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E
Characteristics of viral menigitis--> MCC is Herpes
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| cirus
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the other clue is IV drug abuse--> so u should suspect HIV & so the MC cause is HSV
(in an IV Drug abuser----> always think of HIV in CNS sympt & Staph in Bone & CVS)
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| khorshid
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E
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| DeltaF508
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Just wondering; why would we think Herpes if there is no RBCs in the CSF and also his CSF glucose is 35; I thought it would be Cryptococcal meningitis... can anybody explain pls? Thanks
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| wywywy2006
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I think it's cryptococcosis
It's an meningitis not encephalitis.
Herps encephalitis doesn't occure more frequently in AIDS than those people with normal immune system
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| radonc
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This sounds like cryptococcal meningitis. It fits better with the 2 mth long history of fevers/headache.
I don't think this is HSV because patients would either be dead or recover completely by 2 mths. Such viral meningitis would present with more RBC's on CSF, and CT may show changes in the temporal lobes.
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| cirus
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so ur saying that a pt as u say would have cryptococcal mengitis for 2 ms & still be alive, the 2 months here aren't by anymean indicative of how long he had his CNS disease..
& in if my memory doesn't fail me, I remember that Dr Conrad said that the most comman cause of Encephalitis is HSV ESPECIALLY in HIV pt..??
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| elitoki
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Answer is E
Look for lab value. VI nerve palsy , PE and CT findings.
Edited by elitoki on 07/24/07 - 12:38 PM
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| elitoki
Forum Guru
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Reading again Q.... mmmm
the glucose is slightly low Nl is 40~70, so it could be cause by cryptococcus.
My answer is C.
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| radonc
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Fungal meningitis can present as a chronic illness, much like tuberculous meningitis, with >1mth history of low-grade fevers, headaches, meningism.
I think viral meningitis/encephalitis is usually self-limiting, or it can be very serious, like HSV enceph (where you need to treat).
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| dr_arc
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hi was getting frustrated withthis question, searched and found this on emed,this looks like crptococcus. the nerve palsy is seen in crypto. i guess most of us who thought of hsv were getting distracted by that ansd the presence of bcs, which is tooless to qualify for hsv. also the slow course.
eMedicine - Meningitis : Article by Marjorie Lazoff, MD
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| hanwin
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History, CSF+ ventricular enlargement= obstruction of flow
?TB meningitis.
Could it be bacterial meningitis?
any comment
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| dr_arc
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hanwin wrote:
History, CSF+ ventricular enlargement= obstruction of flow
?TB meningitis.
Could it be bacterial meningitis?
any comment
hey hanwin , dude this is a really interesting perspective,
definitley plausible , a hiv pt , low grade fever and ventricular enlargement on ct could be TB, but the focal neurological finding is troubling me. that doesnt fit into the tb picture.
a TB tuberculoma would more likely give this picture but the ct rules it out, so i guess we are left with cryptocoocus, that fits in with the picture of systemic features of fever wt loss and the cranial nerve involvement.
pls let me know wht you think
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| manolok
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This is a bacterial menigitis, the CSF findings fit only the criteria for a bacterial etiologic agent. I don't know which bug though. probably, TB. Couldn't be viral nor aseptic because these type of mengitis have normal glucose findings and normal to slightly increased protein and pressure levels.
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