BOF:
126
A 68
year old male is admitted with a history of headache and confusion. He is
known to have mild hypertension controlled with the use of a thiazide
diuretic.
Since admission the patient has had two witnessed seizures.
On
examination he is febrile confused and agitated. It is not possible to do a
full neurological examination but there appears to be a right sided weakness,
there is no neck stiffness and Kernig’s sign cannot be elicited.
A CT
scan is preformed and this shows diffuse oedema mainly in both temporal lobes.
A
lumbar puncture is performed the results are as follows:
Opening pressure 150 mm of H2O
Protein 0.48 g/L
Glucose 4.3 mmol/L (blood glucose 5.5 mmol/L)
Cell
count 12 /mL (lymphocytes)
In
this patient which one of the following drugs would you commence immediately?
a)
Acyclovir
b)
Dexamethasone
c)
Mannitol
d)
Ceftriaxone
e)
Phenytoin sodium
