1. If patient is in coma or has papilledema or focal neurological signs -* exclude an intracranial mass with a CT scan. If the patient is deteriorating rapidly, or has a bleeding disorder that cannot be rapidly corrected, take off blood cultures and commence antibiotics (see below) prior to scanning.
2. If above signs are absent or CT scan excludes a mass lesion -* confirm diagnosis with a lumbar puncture and identify the organism.
CSF examination - moderate increase in pressure < 300 mm CSF.
Gram + ve paired cocci Gram - ve bacilli Gram-ve intra and extracellular cocci = pneumococcus - haemophilus = meningococcus
- cell count is elevated, 100-10 000 cells/mm3(80-90% polymorphonuclear leucocytes).
- glucose is depressed.
- enzyme lactic dehydrogenase is elevated.
- culture CSF
- countercurrent Immunoelectrophoresis detects capsular antigen in CSF; leads to rapid diagnosis if CSF microscopy is unhelpful, especially if patient has already started antibiotics.
- Organism isolated in 80% of cases of Haemophilus meningitis.
- Pneumococcus and meningococcus in less than 50% of patients.
3. Check serum electrolytes.
- important in view of the frequency of inappropriate antidiuretic hormone secretion in meningitis.
4. Detect the source of infection.
- Chest X-ray - pneumonia
- Sinus X-ray - sinusitis
- Skull X-ray - fracture
- Petrous views - mastoiditis
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