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12th August 2024
A 62-year-old female presents to her GP with a headache which has been present for the last month
A 62-year-old female presents to her GP with a headache which has been present for the last month. On further questioning she has been feeling tired and generally unwell. She hasn’t been eating that well and has noticed her clothes are getting looser. She has a past medical history of alcohol excess, anaemia, hypothyroidism and schizophrenia. Her observations show a temperature of 37.7 degrees Celsius. She has some difficulty flexing her neck. Her GP is concerned and calls an ambulance to take her to A&E for further assessment. She has a CT head which is normal. CXR shows hilar adenopathy.
Blood tests are performed, showing:
| Hb 108 (115-165) | WBC 8.1 (4-11) | K⁺ 3.8 (3.5-5.3) | CRP 86 (<5) |
| MCV 89 (80-100) | Na⁺ 128 (133-146) | Creatinine 81 (45-84) | Glucose 8.2 |
The lumbar puncture results are as follows:
| WBC 405/mm³ (predominantly lymphocytes) | Glucose 2.9 mmol/L |
| Ziehl-Neelsen stain: No acid fast bacilli seen | Protein 1.8 g/L |
What is the most appropriate treatment?
Select the SINGLE most appropriate option from the list below. Select ONE option only.
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