Below is a link to the clinic directory for UT Southwestern Internal Medicine Residency.
Daily Archives: March 25, 2015
Viral Hepatitis 101
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)
Spinal Tap!
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) |
| Protein (g/l) | <0.5 | 0.5–0.9 | >0.9 | >0.5 | >1.0 | >1.0 | Normal |
| Glucose (% serum glucose) | >60–75% | Normal | <40% | <80% | <50% | Normal | Normal |
Adapted from Clarke et al.
CT before LP?
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:
Case Challenge #9
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History
- 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.
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Physical Exam
- Tmax 99.8 F
- Heart sounds:
- Bilateral basilar crackles
- Left sided weakness
- Petechiae on fingertips
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Labs
- WBC 12k, ESR 75, CRP 8.5.
- Blood cultures negative ngtd.
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Imaging
- 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)
