Below is a link to the clinic directory for UT Southwestern Internal Medicine Residency.
An Update on Viral Hepatitis, by Dr. Geri Brown
(note: the slideshow can only be seen on our site – click the title above to access it)
No, not the parody English heavy metal band, but the procedure to help identify infectious and auto-immune diseases effecting the central nervous system. Below is a summary of the expected CSF findings in a variety of conditions:
Routine CSF constituents in different CNS disorders
|Normal||Viral infection||Bacterial infection||Fungal infection||TB infection||GBS||Multiple sclerosis|
|Appearance||Clear||Clear or opaque||Turbid||Clear||Clear/opaque||Clear||Clear|
|White cells (per mm3)||0–5||10–2,000||100–60,000||20–500||50–5,000||Normal||>15 atypical (>50 very rare)|
|Glucose (% serum glucose)||>60–75%||Normal||<40%||<80%||<50%||Normal||Normal|
Adapted from Clarke et al.
You have a patient in the ER in whom you suspect bacterial meningitis. Time to perform a lumbar puncture, right? In many cases, the patient ends up receiving a CT head before the procedure is performed, but is this the best approach? To help answer the question, the IDSA guidelines for CT before LP are below:
- A 52 year old female presents with fever, new-onset weakness, and dyspnea on exertion. This is associated with weight loss and a rash. She denies current or previous drug use. No pets or recent travel.
- Tmax 99.8 F
- Heart sounds:
- Bilateral basilar crackles
- Left sided weakness
- Petechiae on fingertips
- WBC 12k, ESR 75, CRP 8.5.
- Blood cultures negative ngtd.
- Brain MRI shows multifocal acute CVA in different vascular distributions.
(Note: this post contains an audio clip, so it must be listened to on the website! Click on the title above)