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12th August 2024
A 69-year-old man is brought into hospital by ambulance after having a seizure at home
A 69-year-old man is brought into hospital by ambulance after having a seizure at home. His wife reports that he has been unwell for 2 weeks with fevers and muscle aches, which they thought was due to the flu. Two days ago he started complaining of a headache. He then became very confused, drowsy and appeared to be hallucinating. On examination, he has a GCS of 11/15 (E2, V3, M6), a temperature of 38.3 degrees Celsius, BP 121/67, HR 108, RR 17 and oxygen saturations 93%. There is no neck stiffness and neurological examination does not reveal any focal neurology.
Blood tests and septic screen are performed:
| Hb 133 (135-180) | Plts 290 (150-400) | K+ 4.8 (3.5-5.0) | CRP 96 (<5) |
| WBC 13.7 (4-11) | Na+ 135 (135-145) | Creatinine 66 (45-84) | CXR: normal |
| Urine dip: protein +, ketones +, leucocytes + | CT head: normal |
Lumbar puncture results show:
| WBC 120/mm³ (predominantly lymphocytes) (<5) | Protein 1 g/L (0.2-0.45) | Glucose 4.6 mmol/L |
What is the most likely diagnosis?
Select the SINGLE most appropriate option from the list below. Select ONE option only.
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