BOF: 50
A 75 year old male is brought to see you by his daughter
and son-in-law as they felt he was becoming increasingly confused and having
difficulty in walking. He lived with them after the death of his wife a year
back.
He was a known hypertensive well controlled on
bendroflumethiazide. He was incontinent of urine but the family put it down to
the fact that he was on a diuretic.
On examination he was afebrile, pulse 80 beats per minute
regular, blood pressure 140/80.
He was conscious and alert and orientated well in person
but not in place and time .his short-term memory was very poor and he
compensated for this by confabulation. There was no cranial nerve lesion,
motor and sensory examinations were normal and there was no neck stiffness or
Kernig’s sign.
His gait was unsteady and wide based and he needed
assistance, as he tended to fall easily.
Investigations
Sodium 136 mmol/L
Potassium 3.8 mmol/L
Urea 7.3 mmol/L
Calcium 2.2 mmol /L
Albumin 38 g/L
Hb 12.5 g/dL
WBC 6.5 x 109 /L
Platelets 400 x 109 /L
ESR 35 mm in 1st hour
B12 250 ng/L
Folate 4.5 mg/L
TSH 4 mU/L
A CT scan of his head was performed and following this
the patient had a lumbar puncture.
Where the lumbar puncture is concerned in this patient
you would expect the CSF to be:
a)
High pressure
b)
Normal pressure
c)
High in protein
d)
High in lymphocytes
e)
Xanthochromic with high protein content, normal cell count
