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 BOF 94

 

   

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BOF: 94

A 38 year old male presents with a history of dull headache of a few weeks duration. In addition he had felt generally unwell with mild fever and lack of appetite. No past illnesses of note, he was not on any drugs.

On examination you note that he is ataxic and there is a sixth nerve palsy on the right side.

He has a CT scan show meningeal enhancement and dilated ventricles

 

CSF

Opening pressure 300 mm H2O

Protein 2.2 g/L

Cells 60 /mL (90% lymphocytes)

Glucose 0.5 mmol/L

 

Blood

Hb 13.5 g/dL

WBC 11 x109/L

Glucose 6.0 mmol/L

 

After microbiological evaluation of the CSF the patient is commenced on appropriate antimicrobial agents. However, a few days after this the patientís level of consciousness begins to deteriorate.

 

Blood tests show

Sodium 134 mmol/L

Potassium 3.8 mmol/L

Urea 7.0 mmol/L

 

In this situation your next step would be to use:

a)      Steroids

b)      Mannitol

c)      Fluid restriction

d)     Streptomycin

e)      Hypertonic saline

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