16th August 2024

A 39-year-old man is brought to the Emergency Department by his partner. She reports that he has been increasingly confused

A 39-year-old man is brought to the Emergency Department by his partner. She reports that he has been increasingly confused in the last 48 hours and has been complaining of a worsening headache. That morning, he had vomited profusely and then became quite drowsy, which is when she called for the ambulance.

She reports that he was previously fit and well but had started to become more lethargic in the last few weeks, with some fevers, which were assumed to be a cold. They are both post-PhD scholars from the north of India but have been in the UK for over 6 years. Both also had chest X-rays as part of the visa screening, which she reports were normal.

His observations are notable for a tachycardia of 122 bpm and a temperature of 38.1℃.

On examination, there is meningism.

Which single option is least compatible with a diagnosis of tuberculous meningitis?

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