Very important Q - bijan

[ArchivalUser]

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
What is the most likely cause of this patient's neurologic findings?
Bacterial or Virus?

[ArchivalUser]

Sounds like a viral infection. Since lymphocytes dominant.

[ArchivalUser]

Yeh, me too. But my question is why there is Erythrocyte count?

[ArchivalUser]

Because bleeding occurs inside the CNS. Infection can lead to bleeding, can't it?

[ArchivalUser]

This patient looks like HSV encephalitis. Is it one of your choices? RBC can be increased in CSF, plus the high lymphocyte profile. Next time, could you give the full Q please?

[ArchivalUser]

yes, that's right. you are excellent.

[ArchivalUser]

any inflamation process causes inc in ESR

[ArchivalUser]

He is not talking about ESR, but erythrocyte counts-RBC counts.

[ArchivalUser]

ok purple

[ArchivalUser]

Herpese encephalitis-