Question:
A 25 year old lady with a history of fever for 1 month presents with headache and ataxia. Brain imaging shows dilated ventricles and significant basal exudates. Which of the following will be the most likely CSF finding?
A 25 year old lady with a history of fever for 1 month presents with headache and ataxia. Brain imaging shows dilated ventricles and significant basal exudates. Which of the following will be the most likely CSF finding?
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Chronic fever with basal exudates and hydrocephalus screams a granulomatous meningitis that eats glucose.
Updated On: Jun 23, 2026
- Lymphocytosis, low glucose, high protein
- Lymphocytosis, normal glucose, high protein
- Lymphocytosis, low glucose, normal protein
- Neutrophilia, low glucose, low protein
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The Correct Option is A
Solution and Explanation
Diagnosis: A young woman with a month of fever, headache, ataxia, hydrocephalus (dilated ventricles) and significant basal exudates points to Tubercular Meningitis (TBM).
Why option A: TBM produces a chronic lymphocytic meningitis. The classic CSF triad is lymphocytic pleocytosis, low glucose (organisms consume glucose) and high protein (inflammatory exudate and blocked CSF flow).
Pathology clue: The hallmark of TBM is dense inflammatory exudate around the basal cisterns, which traps cranial nerves and blocks CSF outflow, causing hydrocephalus and the dilated ventricles seen on imaging.
Why the others are wrong: Normal glucose (B) fits viral meningitis. Normal protein (C) is against an exudative process. Neutrophilia with low protein (D) is not the TBM picture; neutrophils dominate pyogenic bacterial meningitis, which is acute, not a month-long course.
Ref: Harrison's Principles of Internal Medicine, 20e.
Why option A: TBM produces a chronic lymphocytic meningitis. The classic CSF triad is lymphocytic pleocytosis, low glucose (organisms consume glucose) and high protein (inflammatory exudate and blocked CSF flow).
Pathology clue: The hallmark of TBM is dense inflammatory exudate around the basal cisterns, which traps cranial nerves and blocks CSF outflow, causing hydrocephalus and the dilated ventricles seen on imaging.
Why the others are wrong: Normal glucose (B) fits viral meningitis. Normal protein (C) is against an exudative process. Neutrophilia with low protein (D) is not the TBM picture; neutrophils dominate pyogenic bacterial meningitis, which is acute, not a month-long course.
Ref: Harrison's Principles of Internal Medicine, 20e.
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