A 55-year-old man presents with fever, headache, and altered sensorium for 2 weeks. CSF analysis shows: protein 200 mg/dL, glucose 25 mg/dL (simultaneous blood glucose 110 mg/dL), and lymphocytic pleocytosis with 500 cells/μL. Ziehl-Neelsen stain shows acid-fast bacilli. At autopsy, the most characteristic gross finding in the meninges would be:

• A Diffuse purulent exudate over the cerebral convexities
• B Multiple ring-enhancing lesions in the basal ganglia
• C Thick, gelatinous, basal cistern exudate with tubercles ✓
• D Temporal lobe hemorrhagic necrosis

Explanation

Tuberculous meningitis characteristically shows a thick, gelatinous, fibrinous exudate predominantly in the basal cisterns, with visible tubercles. This basal predominance differentiates it from pyococcal meningitis (convexities). The CSF profile of low glucose, high protein, and lymphocytic pleocytosis is classic. Cranial nerve palsies and hydrocephalus are common complications due to the basal exudate.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.