47 years old female patient on & off fever from last 3 months headache from 10 days along with 10-15 episodes of vomitting lethargic from 5-6 days episode of abnormal body movements 2 days back now admitted in hospital from 2 days. altered sensorium and drowsiness present unable to speak properly dioriented to time place and person PAST HISTORY:- hypothyroidism from 18 years type 2 DM from 7 years DRUG HISTORY: pt is on antipyschotics for schizophrenia missed antipsychotic doses from last 10 days ct scan normal csf analysis suggestive of TBM MRI and PCR TB reports are attached plzz give ur valuable advice

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What is corresponding sugar ? Csf protein is raised and sugar is appears ok if blood sugar is good. what about fungal stain, cryptococcal antigen .This csf report is not very much informative in view of high rbcs Still required to r/o metabolic causes as hyponatremia , hyperglycemia , other electrolyte imbalance What was anti psychotic medication if it was lithium again electrolyte have to check , what about hypothyroid status ??? is there no hydrocephalus in ct despite of high protein

Blood sugar is in range of 150-160 Hyponatremia was there initially... But now under control Antipsychotics were risnia plus and rivotril 0.125 mg No hydrocephalus ct scan is completely normal TSH is normal now
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Ask for CB NAAT X RAY CHEST PA VIEW CT SCAN OF BRAIN

Ok sir
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Fungal meningitis is one thing to be ruled out. Pls send for CSF Culture ATT and long term steroids are important part of management.

Presence of hyponatremia supports TBM, There are no specific investigations for TBM , but in India benfit of doubt Can always be given to it. Also neuroimaging to rule out encephalitis and vasculitis is important
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Anti tubercular drugs Antiinflamatory drugs

Thnku for ur valuable suggestions

MRI reports

PCR TB reports

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