Neurological Disorders Q 63 - Gyan Darpan : Learning Portal
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Monday, 18 April 2022

Neurological Disorders Q 63

A lumbar puncture is performed on a child suspected of having bacterial meningitis. CSF is obtained for analysis. A nurse reviews the results of the CSF analysis and determines which of the following results would verify the diagnosis?
     A. Cloudy CSF, decreased protein, and decreased glucose.
     B. Cloudy CSF, elevated protein, and decreased glucose.
     C. Clear CSF, elevated protein, and decreased glucose.
     D. Clear CSF, decreased pressure, and elevated protein.

Correct Answer: B. Cloudy CSF, elevated protein, and decreased glucose.

A diagnosis of meningitis is made by testing CSF obtained by lumbar puncture. In the case of bacterial meningitis, findings usually include an elevated pressure, turbid or cloudy CSF, elevated leukocytes, elevated protein, and decreased glucose levels.

Option A: Patients presumed to have bacterial meningitis should receive a lumbar puncture to obtain a cerebrospinal fluid (CSF) sample. The CSF should be sent for Gram stain, culture, complete cell count (CBC), and glucose and protein levels. Bacterial meningitis typically results in low glucose and high protein levels in the cerebrospinal fluid.
Option C: As CSF glucose levels are dependent on circulating serum glucose levels, the CSF to serum glucose ratio is considered a more reliable parameter for the diagnosis of acute bacterial meningitis than absolute CSF glucose levels. A neutrophil predominance on cell count would be expected.
Option D: A clear CSF is normal. Symptoms are similar to aseptic meningitis, but clinical presentation is much more severe. Additional symptoms include altered mental status, seizures, and focal neurologic signs. Diagnosis is also possible via LP. CSF is usually cloudy in appearance, with a low glucose level, and potential positive gram stain and culture. Patients presumed to have bacterial meningitis should immediately receive broad-spectrum antibiotics to prevent clinical deterioration.

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