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 Best of Five 26

 

   

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BOF: 26

A 50-year-old female presents with a sudden onset occipital headache followed by a decreased level of consciousness. On examination she has neck stiffness and a positive Kernig’s sign. CT scanning shows blood in the sub-arachnoid and intraventricular space.

The patient improves initially but 10 days following admission her level of consciousness begins to deteriorate.

The next step in management would be:

a)      Decompression by lumbar puncture

b)      Lumbar puncture followed by high dose broad spectrum antibiotics until cultures are available

c)      High dose dexamethasone

d)      CT scan followed by a ventricular jugular shunt

e)      Cisternal puncture for decompression

 

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