Victor
45, Male
Click on the tabs below to view the results and interpretation of the investigations.
Imaging of the head
A computerized tomogram (CT) scan is carried out as soon as possible but a magnetic resonance imaging (MRI) scan must be carried out as this investigation is of higher sensitivity. MRI head : showing a lesion in the right medial temporal lobe which is enhanced with gadolinium, a contrast medium. There was no papilloedema on fundal examination and the scan showed no cerebral oedema ensuring a lumbar puncture could be carried out.
(SOURCE: http://casemed.case.edu/clerkships/neurology/Web%20Neurorad/hsvsummary.htm)
Laboratory Tests
The following investigations are requested:
Lumbar Puncture (LP):
- Collect cerebrospinal fluid (CSF, virology)
-
Microscopy, culture and sensitivity (MC&S):
- Cell count (red and white blood cells and proportion)
- Gram stain (for bacteria)
- Bacterial culture
- Viral PCR
- Acid fast bacilli smear (AFB) and Mycobacterium tuberculosis (TB) culture if risk factors
-
Biochemistry:
- Protein
- Lactate
- Glucose (paired with a plasma sample)
Other Microbiology tests:
- Blood culture
- Posterior nasopharyngeal swab
- Urine sample
- Whole blood sample for meningococcus and pneumococcus PCR
- HIV type 1 and 2 antibody and antigen test
Results
| Cerebrospinal fluid (CSF) Features | Normal | Bacterial infection | Viral infection | Victor’s sample |
|---|---|---|---|---|
| Opening pressure (cm H2O) | 12-20 | Raised | Normal / Mildly raised | Mildly raised |
| Appearance | Clear | Turbid | Clear | Clear |
| White cell count (c/uL) | < 5 | Raised | Raised | 40 |
| Differential count | n/a | Neutrophils | Lymphocytes | Lymphocytes |
| CSF protein (g/L) | < 0.4 | Raised | Mildly raised | 1.2 |
| CSF plasma/glucose ratio | > 0.66 | Very low | Normal | 0.9 |
| Real time polymerase chain reaction (PCR) tests for: | |
|---|---|
| Herpes simplex virus types 1 and 2 DNA | HSV DNA type 1 : Detected |
| Varicella zoster virus DNA | Not detected |
| Enterovirus RNA | Not detected |
| Cytomegalovirus DNA | Not detected |
| Epstein Barr virus DNA | Not detected |
| Adenovirus DNA | Not detected |
| Other Microbiology Tests: | |
|---|---|
| Blood culture | No growth |
| Posterior nasopharyngeal swab | No growth |
| Urine sample | Legionella antigen negative |
| Whole blood sample for meningococcus and pneumococcus PCR | Negative |
| HIV type 1 and 2 antibody and antigen test | Negative |