CSF Study Interpretation:
|Normal||Bacterial Meningitis||Viral Meningitis||Fungal/TB|
|Opening Pressure (cm H2O)||< 15||↑↑||Normal/mild ↑||Variable (very elevated with crypto)|
|Protein (mg/dL)||15-45||↑||Normal/mild ↑||↑|
|WBC||0-8||↑↑ (>1000)||↑ (5-300)||↑|
|WBC differential||Even||>80% PMNs||>50% Lymphs, <20% PMNs||50-80% Lymphs|
|Gram Stain||Normal||60-90 % +||N/A||37-87% AFB +|
CT Before LP:
1) Altered Mental Status / Fecal Deficits
3) History of CNS disease – mass lesion, stroke, etc.
4) Seizure within 1 week of presentation
Bad causes of headache to always think about:
– Meningitis (or other CNS infection)
– Tumor/Space occupying lesion
– Temporal arteritis
Headaches: POUND – Pulsatile, One day, Unilateral, Nausea, Disabling
Epi: 3x more common in adult females; peaks in the 5th decade of life
S/S: unilateral, throbbing headache, +/- photophobia/phonophobi/nausea
Epi: stress/sleep disruption are common triggers
S/S: bilateral, steady, mild-moderate discomfort
Epi: male sex/tobacco use are risk factors; typically occurs within a few hours of falling asleep
S/S: periorbital/temporal intense pain usually ipsilateral; can develop autonomic features such as ptosis, lacrimation, conjunctival injection, and rhinorrhea
Clinical Manifestations of VZV:
Rash: erythematous papules progressing to grouped vesicles; usually limited to one dermatome, but can affect 2-3 neighboring dermatomes. Thoracic/Lumbar dermatomes are most commonly involved.
Acute neuritis: most common symptom; 75% have prodrome of pain – usually described as “burning, throbbing, stabbing.”
HZ Ophthalmicus: serious, sight-threatening condition caused by VZV reaction within trigeminal ganglion. Usually preceded by prodrome of headache, malaise, fever.
Hutchinson’s Sign: vesicles on the tip of the nose – associated with HZ opthalmicus.
Ramsey-Hunt Syndrome: major otologic complication of VZV reactivation.
Triad (typicially) 1) Ipisilateral facial paralysis
2) Ear pain
3) Vesicles in auditory canal