50 yr / M diabtetic- 5 years hypertension diagnosed 10 days back c/o severe headache first on the upper occipital area now has shifted to mid frontal area fluctuating blood pressure h/0 fever - 3days with the onset of headache- 7 days back h/o vomiting- 1 episode h/o constipation-5 days inv: cbc-n urine albumin- increased rft- normal lft-normal ct scan- ethmoidal sinusitis otherwise normal ct ecg- normal usg abd- normal diagnosis and management?



The patient has fever, vomiting, headache of different durations for past 7 days. Occipital headache with frontal headache, maybe bilateral. Any neck pain? Fundus examination? With the presentation , I would prefer to rule out 1. meningoencephalitis 2. Cvt CT brain may be normal in both. Sinusitis may be a source of nasal spread for meningitis especially in view of uncontrolled diabetes. I would suggest a venogram and a lumbar puncture examination with opening pressure as well. As per guidelines, first dose of antibiotic and steroid (10 mg dexamethasone prior to or with antibiotic followed by 4 mg q8h- q6h) can be given before the tests. In view of age of 50 years and above , third generation cephalosporin and vancomycin can be initiated followed by specific antibiotic as per report. Do take a consult with the neurologist available there.

For dm 2, tell me the fbs, ppbs, hba1c status, medication status. For htn, what's the BP..? Is he on any sort of medications..? Add a ace inhibitor or ARB if not taking it. For headache, ethmoidal Sinusitis - tab amoxyclav 625 bd, tab pacimol active 1 tab sos, tab levocetrizine 10 od before food. For constipation, softovac sf - 2tsp in half glass water hs, Add a ppi to it.

fbs: 220 hba1c: 9 pt is on insulin now bp 170/90 mmhg nw on clonidine any other pathology to b ass with headache? do v hav to do any additional inv?

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@Dr. Umesh Patnaik @Dr. Siba Dalai diagnosed as varicella Zoster meningitis prognosis? treatment?

is it contagious

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I agree with Dr S Dalai

@Narayan Pal diagnosis?

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