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28th May 2025
A 25-year-old lady presents with a 2-day history of headache, nausea, and vomiting.
A 25-year-old lady presents with a 2-day history of headache, nausea, and vomiting. This morning she has developed neck stiffness and sensitivity to light. She has no significant past medical history but is currently 10 weeks pregnant. She is up to date with her antenatal checks and no concerns have been raised. She mentions she attended a local cheese and wine tasting event last week with her friends and had a few episodes of diarrhoea the next day. On examination, there is no focal neurology, and no papilloedema is present.
A CT head is normal, and a subsequent lumbar puncture reveals:
| Appearance | Fibrinous | |
| Protein | 0.9 g/L | (<0.45 g/L ) |
| Glucose | 1.9 mmol/L | (2.5-4.4 mmol/L ) |
| White cells | 240 cells/μL (predominantly lymphocytes) | (<5 cells/μL) |
| Gram stain/ culture | No organisms | |
Wet mounts of CSF samples show tumbling motility of organisms.
Of the options below, what is the most likely diagnosis?
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