15th August 2024

A 29-year-old male is referred to you with headache and neck stiffness

A 29-year-old male is referred to you with headache and neck stiffness. He reports a short history of fever and malaise prior to the gradual onset of headache, which has been accompanied by neck stiffness and nausea. He is usually fit and well. His observations are remarkable only for a tachycardia of 104 beats per minute.

On examination, he is alert and oriented. There is no focal neurology, though examining his pupillary reflexes is difficult due to photophobia. You note nuchal rigidity. There is no rash.

His serum glucose on venous blood gas is 6.1 mmol/L.

Normal ranges:

• CSF white cell count: 0-5
• CSF protein: 0.15-0.45
• CSF glucose: ~ >60% plasma concentration

Which is the single most likely result of a lumbar puncture?

Select the SINGLE most appropriate option from the list below. Select ONE option only.