Vol 2:1 Answer

Thank you to everyone who participated.

The Question

The answer is a.
This patient presents with symptoms consistent with meningitis. Antibiotics are administered empirically as diagnostic workup proceeds. The best choice in this patient is ceftriaxone, which has good CNS penetration. In order to avoid transtentorial herniation in this patient with a neurologic deficit (confusion), a non-contrast head CT should be performed prior to LP. It is controversial whether or not a head CT needs to be performed prior to all LPs. However, if there is papilledema or a neurologic deficit, then head CT is mandatory.

(b) It is not prudent to wait for results from a head CT. This will only delay treatment of a potentially fatal disease. (c) Although this patient can benefit from acetaminophen and hydration, starting antibiotics empirically is more important. In addition, this patient requires a head CT prior to LP. (d & e) As previously stated, antibiotics should be started early in management and not be delayed while waiting for results.

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