Page 1 of 1: paeds-- meningitis

candy · Credits: 15282 My Scrapbook

A 4 year old boy is brought to pediatric emergency with complaints of fever and vomiting. Clinical examination reveals neck rigidity. CSF shows Protein 200mg %, sugar 50mg %, chloride 550 meq/dl. The most probable diagnosis is

a) Pyogenic meningitis
b) Tubercular meningitis
c) Aseptic meningitis
d) Brain abcess

another scenario

A 8 year old girl presents to the pediatric emergency with 3 day history of fever ( 101F ), vomiting, headache and seizures. CSF finding shows sugar 40mg %, Protein 200mg % with neutrophils 60% and lymphocyte 40%. The most probable diagnosis

a) Pyogenic meningitis
b) Tubercular meningitis
c) Viral meningitis
d) Brain abcess

can u tel the ans for both and support with explanation??

manpreet108 · Credits: 30682 My Scrapbook

A 4 year old boy is brought to pediatric emergency with complaints of fever and vomiting. Clinical examination reveals neck rigidity. shows csf
Protein 200mg %, sugar 50mg %, chloride 550 meq/dl. The most probable diagnosis is

a) Pyogenic meningitis
b) Tubercular meningitis
c) Aseptic meningitis
d) brain abscess

relevant info-----
signs of raised ICP.
protein is raised .--can be seen in any type--pyo,tubercular,viral
sugar is normal----rules out bacterial and tubercular.

so the ans must be viral meningitis....

A 8 year old girl presents to the pediatric emergency with 3 day history of fever ( 101F ), vomiting, headache and seizures. csf
finding shows sugar 40mg %, Protein 200mg % with neutrophils 60% and lymphocyte 40%. The most probable diagnosis

a) Pyogenic meningitis
b) Tubercular meningitis
c) Viral meningitis
d) brain abscess

relevant info---

raised ICP.
sugar is decreased---can be both pyogenic and tubercular.
protein raised--can be any of viral ,pyo or tubercular.
cell count--both lymphocyte and neutrophils---this supports the diag of pyogenic--as pyo has predominat neutrophils...

so ans to this shd be pyogenic meningitis.

i hope u agree.

candy · Credits: 15282 My Scrapbook

what is the significance of csf chloride in 1st case?
i agree that 2nd one shld be pyogenic..
why cant 1st one be tb meningitis??

btw, ans given 4 both is TBM!!!

candy · Credits: 15282 My Scrapbook

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parin · Credits: 14560 My Scrapbook My Reading List 1 Books

A 4 year old boy is brought to pediatric emergency with complaints of fever and vomiting. Clinical examination reveals neck rigidity. CSF shows Protein 200mg %, sugar 50mg %, chloride 550 meq/dl. The most probable diagnosis is

a) Pyogenic meningitis
b) Tubercular meningitis
c) Aseptic meningitis
d) brain abcess

See, in this case, we have to decide only from protein, sugar & chloride..
for pyogenic, they are protein >45 mg%, sugar <40 mg% or less than 40% of BS & chloride not imp....

for Tb, they are protein 10-500 mg%, mildly decrease sugar i.e., about 2/3 of BS & chloride <600 mEq/dl....

for viral, they are protein N or slightly elevated 20-80 mg%, sugar almost N & chloride not imp...

So what is here is Tb meningitis, as sugar 50 mg% & esp chloride 550 mEq/l favour it..

A 8 year old girl presents to the pediatric emergency with 3 day history of fever ( 101F ), vomiting, headache and seizures. CSF finding shows sugar 40mg %, Protein 200mg % with neutrophils 60% and lymphocyte 40%. The most probable diagnosis

a) Pyogenic meningitis
b) Tubercular meningitis
c) Viral meningitis
d) brain abcess

Here I'd say we can't say definitely!!

As fever is 101 F which can be in Tb also..
Sugar & protein are as above so not diagnostic..

So there remains N 60% & L 40%, count not given which would help..
O/w usually neutrophils are 75-95% & that is called predominent neutrophils..
& even in Tb meningitis, in early days(esp 1st 2 days) PMNs may dominate, which are soon replaced by lymphocytes, so it takes 3 days? or they are being replaced?

Any strong point in favour of or against these two?????

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