Which CSF profile is most characteristic of tuberculous meningitis?

• A WBC 500 cells/µL with neutrophil predominance, protein 100 mg/dL, glucose 45 mg/dL, opening pressure normal
• B WBC 3000 cells/µL with neutrophil predominance, protein 350 mg/dL, glucose 15 mg/dL, opening pressure markedly raised
• C WBC 20 cells/µL with lymphocyte predominance, protein 40 mg/dL, glucose normal, opening pressure normal
• D WBC 150 cells/µL with lymphocyte predominance, protein 250 mg/dL, glucose 28 mg/dL, opening pressure raised ✓

Explanation

Tuberculous meningitis produces a moderate lymphocytic pleocytosis, markedly elevated protein because of basal meningeal inflammation and blockage, low glucose, and raised opening pressure. Option B describes pyogenic bacterial meningitis, option C describes enteroviral meningitis, and option A mixes neutrophils with near-normal values seen early in some cases but not characteristic of TB. Indian exam convention emphasises the combination of low glucose with very high protein and lymphocytes as the classic TB pattern.

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

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