A 24 yr old male pt c/o headache ,fever and vomiting since 10 days. o/e vitals - stable. cns - no signs of meningitis. CSF analysis - cell count 100 . cell type - Lymphocytes. how to approach this case ?

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mostly looks like aseptic meningitis there are csf -cell count high we have to treat symptomatically in view of no signs of meningitis clinically. mri brain imaging use ful corelate with csf.

CT brain - normal.
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Depending on short duration of history and CSF picture, viral meningitis is the most probable diagnosis. IV acyclovir should be started without delay.

show MRI contrast do staging of TBM by modified Vellore method see changes in MRI brain with basal exudate STARY ATT and antiviral together If lesion present in MRI go for biopsy streotectic as it is a progressive disease EVD may require for developing hydrocephalus urgently

If you are suspecting Herpetic cause, then Add ACYCLOVIR,

Tuberculus meningitis.

First diffential would be viral meningitis . Treat as Viral meningitis under cover of antibiotics for bacterial meningitis. Simultaneously search for other causes of fever.

Viral meningitis,

Viral meningitis

shall I treat him with Acyclovir sir ?
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Mri brain 100 cell count lymphocyte in favor of tbm

viral meningitis

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