CSF from a patient with 3 weeks of low-grade fever, evening headache, and cranial nerve VI palsy shows 80 lymphocytes/uL, protein 350 mg/dL with a cobweb coagulum on standing, and glucose 30 mg/dL (serum 90). The most likely diagnosis is:

• A Pyogenic meningitis
• B Fungal meningitis due to Cryptococcus
• C Viral meningoencephalitis
• D Tuberculous meningitis ✓

Explanation

Subacute lymphocytic meningitis with markedly raised protein forming a cobweb clot, low CSF glucose, and basal exudate signs like sixth nerve palsy is typical of tuberculous meningitis. Pyogenic disease shows neutrophil pleocytosis and much lower glucose with higher opening pressure, while viral meningitis usually preserves a normal glucose. Cryptococcus occurs mainly in immunosuppressed patients.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.