37 YEAR OLD FEMALE WITH FEVER, NECK PAIN AND ALTERED SENSORIUM

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37 year old female a resident of Dugapally , housewife was brought to the casuality with complaints of 

1. Neck pain since 4 days

2. Fever since 4 days

3. Body pains since 4 days

4. Altered sensorium since yesterday 

HOPI:

Patient was apparently asymptomatic 4 days back then she had neck pain which was insidious in onset and gradually progressive followed by burning of eyes then developed fever associated with chills and rigors din’t subside on medication 

patient’s attender took her to the local RMP for fever and was started on antibiotics.

Patient attender observed altered sensorium since yesterday and was brought to the hospital for further evaluation  

N/K/C/O HTN,DM,THYROID,ASTHMA,CAD

Surgical history: 

History of tympanoplasty 5 years ago 

On presentation:

patient is drowsy arousal to painful stimulus 

VITALS

febrile 101.3 F

B.P - 170/90 mm hg 

PR- 101 bpm

RR: 18 CPM

SYSTEMIC EXAMINATION 

Cvs - s1 s2 heard no murmurs

RS :- NVBS no adventitious sounds

Kernig’s sign positive 

Brudzinski’s sign positive 

Lumbar puncture was performed 

INVESTIGATIONS:

CSF ANALYSIS

TC -112 cells

Dc- predominantly lymphocytes

Rbc’s - Nil

Sugar-38

Protein -102

Chloride-98

BGT: O POSITIVE

APTT: 30 SEC

PT: 15 SEC

INR: 1.11

HEMOGRAM:

HB: 12.9 

TLC: 9,400

PLT: 3.39 L

LFT:

TB: 0.77

DB: 0.18

AST: 20

ALT: 35

ALP: 228

TP: 6.6

ALB: 3.7

A/G: 1.32

RFT:

S. Creat: 0.6

Na+ : 134

Cl- : 96

K+ : 3.0

URIC ACID: 1.8

BLOOD UREA: 17

RBS: 141 MG/DL

CUE:

COLOUR: PALE YELLOW, CLEAR

SP GRAVITY: 1.010

NO ALBUMIN/SUGARS/BILE PIGMENTS/BILE SALTS /RBC

PUS CELLS: 3-4

EPITHELIAL CELLS: 2-3

SPOT URINE PROTEIN: 7.5

SPOT URINE CREATININE : 44.2 

RATIO: 0.16

Chest xray:

ECG:

DIAGNOSIS :

TUBERCULAR MENINGITIS 

TREATMENT :

1. IVF NS and RL @ 75ml/ hour 

2. RT FEEDING 2nd hourly- 200ml 

3. Tab. RIFAMPICIN 600mg 

4. TAB. ISONIAZID 300 mg 

5. TAB. PYRAZINAMIDE 1500mg 

6. TAB. ETHAMBUTOL 1900 mg 

7. INJ. CEFTRIAXONE 2gm/IV/BD 

8. INJ. PAN 40 mg /IV/ BD 

9. INJ. ZOFER 4mg/ IV/SOS 

10. INJ. NEOMOL 100ml (if temp > 101.1F) 

11. Head end elevation by 30 degree

12. Vital monitoring hourly 

13. Fever charting 4th hourly