DrVirgo
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IVDU, HA, Fever, neck stif, febrile, wt. loss, LR weakness, papilledema, ventricular enlargement…pressure inc, glucose dec, protein inc, Lymphocytes inc… Is it Cryptococcal(fungal) or Herpes(viral) Meningitis???
C or E???
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| robin082006
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E
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| dr_arc
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and C . there is a similar thread , infact the same question somewhere here ,
this is cryptococcus. the nerve palsy and rbcs in the csf makes us think of HSv, but the rbcs are too less to qualify for HSv , also the protracted course favours the diagnosis of cryptococcal. nerve palsies are seen with crypto mening.
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| Justice
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C
for E, I would like to see RBCs in his liquor (pathognomonic)
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| DrVirgo
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My first instinct says Cryptococcal, but...
What about "increased lymphocytes"? Isn't that more common with Viral meningitis?
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| elitoki
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Cryptococcal meningitis 180-300 in openin presure; 10-200 lymphocytes;Glucose Reduced; protein 50-200; micro- India ink, cryptococcal antigen, culture
Viral meningitis 90-200in opening pressure; 10-300 lymphocytes; glucose Normal; protein Normal or slightly elevated; micro Viral isolation, PCR† assays
This patient has low glucose and lymphocyte value will not exclued cryptococcal meningitis.
http://www.emedicine.com/med/topic2613.htm
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| Drtweetie
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Crypto is the answer
HSV & crypto both have lymphocytosis, but you would see temporal lobe involvement in CT w/ HSV.
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| dr in trouble
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yes---t shud be crypto
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| DrVirgo
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Good discussion; it helped. thanks. 
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| coolmavs
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Cryptococcal, great job and yes good discussion!
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