A 40-year-old man presents with 2 weeks of low-grade fever, malaise, and progressive cranial nerve palsies (especially CN III and VI). Neck stiffness is present. MRI brain shows basal exudates and hydrocephalus. CSF shows glucose 1.8 mmol/L (low), protein 2.5 g/L (high), and 300 cells/uL (90% lymphocytes). What is the most likely diagnosis?

• A Bacterial meningitis
• B Viral meningoencephalitis
• C Tuberculous meningitis ✓
• D Cryptococcal meningitis

Explanation

Tuberculous meningitis classically presents with basal exudates on imaging, cranial nerve palsies, and hydrocephalus. CSF shows lymphocytic pleocytosis with very high protein and low glucose. Bacterial meningitis typically has a more acute onset and neutrophilic predominance. Viral meningitis usually has normal glucose.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.