tag:blogger.com,1999:blog-4082643038671225434.post2348874565269903295..comments2023-10-07T01:34:01.774-07:00Comments on Case of the Day: Quincke ICraighttp://www.blogger.com/profile/17072102331564743101noreply@blogger.comBlogger3125tag:blogger.com,1999:blog-4082643038671225434.post-52034573038511749552009-03-11T16:50:00.000-07:002009-03-11T16:50:00.000-07:00Very nice - this is meningitis. SAH is important t...Very nice - this is meningitis. SAH is important to exclude (also by LP) but fever and age group suggest against it. Right now, the labels group neurology and psychiatry together - at some point, I might go back and distinguish between the two. Here, it's a neurology case and not a psych one.<BR/>-<BR/>Quincke I<BR/><BR/>This is acute bacterial meningitis with the triad of high fever, mental status change, and nuchal rigidity. The tests suggesting nuchal rigidity include the Brudzinski sign and the Kernig sign. The patient needs a lumbar puncture; screening CT before LP is suggested only if there is a risk factor for a mass lesion (immunocompromised, history of CNS disease, new onset seizure, papilledema, abnormal level of consciousness, or focal neurologic deficit). Empiric antibiotics include third generation cephalosporins (ceftriaxone, cefotaxime).<BR/><BR/>Sources: UpToDate; nlm.nih.gov.Craighttps://www.blogger.com/profile/17072102331564743101noreply@blogger.comtag:blogger.com,1999:blog-4082643038671225434.post-79576451404836206092009-03-10T08:29:00.000-07:002009-03-10T08:29:00.000-07:00The differential diagnoses seem to be:Subarachnoid...The differential diagnoses seem to be:<BR/>Subarachnoid hemorrhage (more likely)<BR/>Meningitis.<BR/><BR/>Next diagnostic test - Head CT scan without contrast. If equivocal, go for lumbar puncture ("Quincke's" puncture?).<BR/><BR/>Empirical treatment - Yes, since getting a CT scan may take time in some places and meningitis cannot be entirely ruled out without it's results.<BR/><BR/>leading diagnosis - SAH<BR/><BR/>The diagrams show Brudzinski's (upper figure) and Kernig's sign. <BR/><BR/>You've co-labelled the post 'Psychiatry'. I didn't get that. Is that because of the marijuana?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4082643038671225434.post-67555103425528681692009-03-09T17:28:00.000-07:002009-03-09T17:28:00.000-07:00kernig?brudzinski?kernig?<BR/>brudzinski?Alexhttps://www.blogger.com/profile/06972701448751949861noreply@blogger.com