case 3 meningitis
TRANSCRIPT
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CASE 3
TUBERCULOUS Meningitis
Stephen A. Ujano
General Data: R.S. 20 y/o, male, from Bangui. Ilocos Norte
Chief Coplaint: Headache
!istor" of #resent $llness:
4 wees !"#, $atient had on and off low grade fe%er, occasional cough and colds.
2 wees !"#, still with on and off fe%er, consult $ri%ate &', was gi%en !aracetamol and (hloram$henicol.
No relief noted. Noted to ha%e )loody s$utum.
* day !"#, still with fe%er, headache, and noted to ha%e + e$isodes of %omiting, hence, consult was done.
#ast Me%i&al !istor":#dmitted for !neumonia 2 months ago
#E:
'(S: B!*20/-0 HR -0 )$m RR 22 c$m
#nicteric sclerae, with cer%ical lym$hadeno$athy
(lear )reath sounds
No murmur, full and eual $ulses
)e*rologi& E+a: &S (onscious, coherent
(ranial Ner%es left lateral rectus $alsy1 3 nuchal rigidity
SAL$E)T ,EATURES:
HIS"5R6
o 20 y/o,
o History of
o low grade fe%er and occasional cough and colds,
o on and off fe%er
o no relief with !aracetamol and (hloram$henicol
o )loody s$utum
o Headache
o 8omiting +9
o #dmitted 2 mos ago due to !neumonia
!H6SI(#7 :#&IN#"I5N
o 8ital Signs "achy$neic 22c$m
o 3 cer%ical lym$hadeno$athy
o (lear )reath sounds
o Neurologic e9am
o &ental Status (onscious and coherent
o 3 left lateral rectus $alsy
o
3 nuchal rigidity
ADM$TT$)G D$AG)OS$S:
o "o consider (entral Ner%ous System Infection secondary to $ossi)le !ulmonary
"u)erculosis
,or*lating the Differential Diagnosis
a. What is the chief complaint?
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- Headache
b. Categorize headache as to Primary or Secondary-Secondary due to an identifia)le cause/disease1 (NS infection.
c. What are the common causes Secondary Headache?
#cute Sinusitis &eningitis Intracranial Hemorrhage Intracranial #)scess Brain "umor "em$oral #rteritis &edication5%eruse Headache most common according to ;H5
d. Determine the headache syndrome as to Acute ecurrent! Acute "on-ecurrent!
Chronic Progressi#e or Chronic "on-Progressi#e. #cute NonRecurrent. "he onset was sudden and occurred &
o Hay =e%er
o 9$osure to $ollutants
o Nasal $assage a)normality $oly$s
o &edical conditions ?R', cystic
fi)rosis
Clinical 'anifestations&
o #cute headache
o =e%er
o =acial $ain/$ressure
o Nasal drainage @ congestion
o (oughing
o SneeAing
o Redness o%er the chees,
nose or eyelids
is$ %actors&
o = > &
o Hay =e%er
o 9$osure to $ollutants
o Nasal $assage a)normality $oly$s
o &edical conditions ?R', cystic
fi)rosis
Clinical 'anifestations&
o #cute headache
o =e%er
o =acial $ain/$ressure
o Nasal drainage @ congestion
o (oughing
o SneeAing
o Redness o%er the chees,
nose or eyelids
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