50yrs male patient brought in ER in drowsy condition with H/o Fever for 4days with rigor and chills. O/ e - Right sided hemiplegia present left lower limb monoplegia left upper limb normal Kerning sign negative no neck rigidity. CSF and MRI brain done Diagnosis and management plan???



CSF examntn reveals inflammation....TLC is also raised and moreover focal neurological signs are s/o Encephalitis or Meningitis...so as told by Dr Anand , go for conservative management with antibiotics and antimalarials..

Contrast mri not done here.this mri doesn't suggest much except for few periventricular ischemic changes.CSF suggestive of meningitis picture with raised protein and counts and decreased sugar.viral meningoencephalitis and cerebral malaria are also a possibility here so treat it accordingly along with antibiotics and antimalarial.unlikely to be tubercular with such a short history.cant correlate hemiplegia with this scan.any history of seizure??

Plantars? Rt hemiplegia and left monoplegia its pointing towards spinal cord lesion. But csf is definitely showing a picture of TB meningitis. Altered sensorium may also be because of encephalitis. Meningeal signs are positive only in 5-10% cases of meningitis so the absence doesn't rule out meningitis.

CSF picture suggest TB meningitis with pachmeningitis with exudate: Steroids/ ict lowering measures., ATT

CSF findings and Imaging suggest TB meningitis but absence of neck stiffness goes against this diagnosis. Cerebral malaria is another possibility.

Sir,Mri spine shows acute transverse myelitis with cord oedema.

View 1 other reply

I agree with Dr S Anand

Dx meningitis RX helliborous or causticum 1m may be try...

Seems to be tubercular TBM

Cases that would interest you