A very young female aged 17 years presented with history of High grade Fever with chills (intermittently) since 7 days with sudden development of Altered Sensorium since 1 day....On asking attendants, history of Occasional Headache was revealed since 1 yr...Virtually no other comorbidity was present...At presentation, GCS was E1V1M1 and pt was unresponsive to any stimuli...No NR or KS was present and pupils were NSNR...Her MRI Brain was done...Comment on her grave condition and how shd she be treated

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Short h/o fever ,but CSF exam in favour of Tubercular meningitis.( Sent CBNAAT of csf I hope.) CSF pleicytosis with predominant lymphocytes, high protein,in favour of TBM. Worth starting her on 4 drug ATT,with anti edema measures and steroids ,fluid support keeping in mind SIADH ,also Pyogenic iv antibiotic cover . GCS being 3 ,she may go in for medullary coning,so ventillatory support is advised right away. CXR ,to look for pulm focus and involve the neurosurgeon in case she needs a shunt.

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1week history of fever with rigor with Acute onset of alt sensorium suggestive sugestive of encephalone involvement.Very low GCS & no mention about meningeal sing but most probably meningoencephalitis. MRI shows meningeal enhancement but very difficult to see MRI properly due to the picture quality .Blood WBC elevated with polymorph predom.CsF turbid with elevated protein & sugar with 600cells , 90% poly.Corresponding blood sugar not available. Usually TBM glucose will be low. Apart from glucose level the CSF picture goes with TBM.Normal or elevated glucose can get in viral but there is no definite gyral enhancement( mri picture difficult to see also)& other CSF parameters are not going well with viral.Needs further CSF analysis for TB.. Start anti TB 4 drug regimen with steroids . Need broad spectrum single antibiotc also in view of the elevated total count in the blood.

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H/ o occasional ha can be ignored as a leading question. CSF glucose is raised. History is of 1 wk high grade fever, polymorph. leucocytosis are all against TBM. IT is either bacterial ( non tb) or viral meningoencephalitis. Do Chest xray. May there be pneumonia.Treat eith abx n acyclovir. IV Fluid restriction, and free water with ryles tube feefs. No hypotonic infusion at all as thid will cause cerebral edema. Sodium is raised, but not alarming. Treat with caution, no hurry.

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Dear Doctor start the treatment like this Inj ÑS Inj RL O2 inhalation Injection Epsolin tds Injection Falcigo Injection meropenem 1gm bd injection Acuvir 250 four times iv and ask for investigation SERUM PCR It might be Bacterial Meningitis Malarial meningitis or Viral Meningitis

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Dd meningoencephalitis TB meningitis send CSF fluid for cbnaat

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Looks like bacterial meningitis.. Short history. Increase TLC.. no comment on ADA? can go for CSF Genexpert.

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Seems to be a c/o tbm.. From the csf study reports.. Even reports of chronic headache suggests tbm.. For the time being Secure airway, if necessary put on a ventilator. Start ATT. Inj dexamethasone 2cc stay then 1 cc 8hrly. Inj. Meropenem 1 g 8hrly. Inj. Pantoprazole. Now the patient also has hypernatremia. So all the iv fluids should be give in halfnor And hypotonic dextrose containing solutions to be added. Regular electrolyte, ur, cr monitoring Lft repeated every 3 days.. Input and output chart

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May be pyogenic meningitis

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Clinically & CSF reports suggestive of TBM ! Other possibilities of Autoimmune Encephalitis Amoebic Encephalitis and Vasculitis to be considered !

What about CT scan, EEG

Sir what is the use of CT after MRI
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