11-23-2007, 12:00 PM
19. A 25-year-old man with a history of intravenous drug use comes to the emergency department because of a progressive diffuse headache, generalized malaise, and low-grade fever for 2 months. During this period, he has had a poor appetite resulting in a 6.8-kg (15-lb) weight loss. His temperature is 38 C (100.4 F). Examination shows ¬¬neck stiffness. Mental status examination shows no abnormalities. Cranial nerve examination shows weakness of the lateral rectus muscle on the right and bilateral papilledema. A CT scan of the head with and without contrast shows moderate ventricular enlargement. Examination of cerebrospinal fluid shows:
Opening pressure 220 mm H2O
Glucose 35 mg/dL
Protein 150 mg/dL
WBC 100/mm3
Lymphocytes 100%
RBC 1/mm
A
) Bacterial meningitis
B
) Cerebral infarction
C
) Cryptococcal meningitis
D
) Glioblastoma multiforme
E
) Herpes simplex encephalitis
F
) Hypertensive encephalopathy
G
) Idiopathic intracranial hypertension
H
) Intracerebral hemorrhage
I
) St. Louis encephalitis
Opening pressure 220 mm H2O
Glucose 35 mg/dL
Protein 150 mg/dL
WBC 100/mm3
Lymphocytes 100%
RBC 1/mm
A
) Bacterial meningitis
B
) Cerebral infarction
C
) Cryptococcal meningitis
D
) Glioblastoma multiforme
E
) Herpes simplex encephalitis
F
) Hypertensive encephalopathy
G
) Idiopathic intracranial hypertension
H
) Intracerebral hemorrhage
I
) St. Louis encephalitis