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:
Decompression by lumbar puncture
Lumbar puncture followed by high dose broad spectrum antibiotics until
cultures are available
High dose dexamethasone
CT scan followed by a ventricular jugular shunt
Cisternal puncture for decompression