Question:medium
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
Show Solution
The Correct Option is A
Solution and Explanation
Pattern recognition: Fever for a month, headache, ataxia, basal exudates and hydrocephalus together name one disease, Tubercular Meningitis. Once you fix the diagnosis, the CSF answer falls out.
The TBM CSF mnemonic: think Low glucose, High protein, Lymphocytes. Mycobacteria sit in the subarachnoid space for weeks, so the cellular response is lymphocytic rather than neutrophilic, the bugs and trapped cells consume glucose, and the thick basal exudate raises protein sharply.
Eliminate by glucose and protein: Viral meningitis keeps glucose normal, so option B is out. An exudative TB process can never leave protein normal, so option C is out. Pyogenic bacterial meningitis is what gives neutrophils, and it raises protein rather than dropping it, so option D is out. Only option A, lymphocytosis with low glucose and high protein, matches.
Clinical pearl: Basal exudate is the anatomical reason for both the cranial nerve palsies and the obstructive hydrocephalus in TBM, so seeing dilated ventricles plus basal enhancement should immediately steer you to this CSF profile.
Ref: Harrison's Principles of Internal Medicine, 20e.
The TBM CSF mnemonic: think Low glucose, High protein, Lymphocytes. Mycobacteria sit in the subarachnoid space for weeks, so the cellular response is lymphocytic rather than neutrophilic, the bugs and trapped cells consume glucose, and the thick basal exudate raises protein sharply.
Eliminate by glucose and protein: Viral meningitis keeps glucose normal, so option B is out. An exudative TB process can never leave protein normal, so option C is out. Pyogenic bacterial meningitis is what gives neutrophils, and it raises protein rather than dropping it, so option D is out. Only option A, lymphocytosis with low glucose and high protein, matches.
Clinical pearl: Basal exudate is the anatomical reason for both the cranial nerve palsies and the obstructive hydrocephalus in TBM, so seeing dilated ventricles plus basal enhancement should immediately steer you to this CSF profile.
Ref: Harrison's Principles of Internal Medicine, 20e.
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