A 3-year-old child presents with 3 weeks of low-grade fever, evening headache, and a left sixth nerve palsy. Lumbar puncture is performed. Which CSF profile is most consistent with tuberculous meningitis?
- A WBC 150/mm3 with 80% neutrophils, protein 60 mg/dL, glucose 55 mg/dL
- B WBC 120/mm3 with 90% lymphocytes, protein 300 mg/dL, glucose 25 mg/dL, cobweb coagulum on standing ✓
- C WBC 900/mm3 with 95% neutrophils, protein 250 mg/dL, glucose 20 mg/dL
- D WBC 30/mm3 with lymphocytes, protein 40 mg/dL, glucose normal, opening pressure normal
Correct answer: B. WBC 120/mm3 with 90% lymphocytes, protein 300 mg/dL, glucose 25 mg/dL, cobweb coagulum on standing
Explanation
Tuberculous meningitis produces modest lymphocytic pleocytosis, markedly elevated protein from basal exudates and blocked absorption, low glucose, and the classic cobweb or spider-web clot formed by fibrin on standing. The neutrophil predominance with very high cell counts in option C describes acute pyogenic meningitis, while the near-normal profile in option D fits viral meningitis. Cranial nerve palsies reflect the thick basal exudates typical of TB.
Reference: Park Textbook of Preventive and Social Medicine, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.