55yrs/M with No significant past medical history Comes to emergency department With H/o High grade fever,Headache and meningismus of acute onset × 2 days,Altered sensorium × 1 day,but there was no H/o Seizure episode,LOC Chief Complaints Fever,Headache, Altered sensorium History No significant past medical history Vitals BP -160/90,Temp -102°F,PR -110,Spo2 -98% on room air,RR -22 Physical Examination Neck stiffness present, Kerning sign negative, increased tone in all four limbs and brisk Stars,Pupils - B/l 4mm RTL,GCS -E2M4V4 Investigations LP is done full of RBCs,S.Ammonia - 222,B.urea - 59,S.Creat - 1.5,S.uric acid - 8.4,WBC -12000,PC -2lakhsNeutrophils -72 Diagnosis ??Meningitis,SAH. SUGGEST WHAT CAN DO FURTHER? Management He is started on empiric antibiotics, Corticosteroid,AEDs,Anti edema measures,Antipyretics, Analgesic,Calcium channel blocker,Lactulose and enema. After initiating treatment patient shows persistent clinical improved.



Both things can co- exist as one of the complications of meningitis is SAH.Subarachnoid hemorrhage (SAH) can be seen with some viral encephalitis, particularly HSV but is a rare complication of bacterial meningitis.

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DIFFUSE SAH,bloid in the sylvian fissure,suprasellar, quadrigeminal ,ambian cisterns with blood in the lateral ventricle and 4th ventricle CTA - No aneurysm detected. His ammonia is elevated,uric acid is high ,deranged RFt. Suggest to start Nomodipine needs rept DSA / CTA after 3 months. Initial small leakage followed by major SAH.Fever can occur in Sah

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As per findings suggest pyogen8c meningitis with SAH Cerebral oedema And bleed in ventricles noted Csf findings are corelating Continue the line taken

Thanx dr Anil Gangani

The MRI scan shows SAH. The signs in meningitis and SAH can overlap like the neck stiffness. History of classical SAH headache should be sought and if present this should be treated as SAH with an eye other causes of his high grade fever including meningitis. LP in this case cannot be assessed. So empirical treatment for meningitis is what can be done.

Sah.only conservative.look for avm or aneurysm present treat menigitis&sah.reduce icp

Subarchnoid haemorrhage Opinion of neurosurgeon Csf haemorrhagic DD meningitis

As a emergency treatment you can use Brhat Vata chintaamani rasa crushed & mixed with Dashamularishta kept under tongue repeatedly for once in 20-30min

aneurysmal sah... urgent neurosurgical evaluation, WFNS grading and treatment thereof

adv to consult neurosurgeon Rx Brihadvat chntamani ras 2bd shankhpushpi ghan tab 2bd Giloy ghan tab 2bd Lodhra powder 1 teaspoon BD withmilk

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