Lab med 34
Headache case studies
Case study [chemistry | microbiology] Principal Laboratory Findings
Downloaded from https://academic.oup.com/labmed/article/34/5/354/2657287 by guest on 02 October 2021
[T1]
Recurrent Headache
and Febrile Attacks Results of Other Diagnostic Procedures
A computed tomography (CT) scan of the brain was
in a Young Woman performed and showed a small calcified lesion to the left of
Ibrahim A. Hashim, PhD, DABCC,1 Mohammed Nabil Richi, the torculax in the posterior fossa which looked like an old
MD, FRCPI2 lesion (possibly an old granuloma, tuberculous or listerial
1 infection, or a residue of some incident in childhood or in-
Departments of Pathology, and 2Internal Medicine, King Khalid
National Guard Hospital, Jeddah, Kingdom of Saudi Arabia fancy) of no current clinical significance. Overall, CT find-
DOI: 10.1309/Y5PTWN3AR6GVRW6T
ings on this admission were similar to those obtained during
her first presentation to the ED 2 years ago. There was no
evidence of hydrocephalus, abscesses, or cysts.
Patient
24-year-old woman. Questions:
1. What is(are) this patient’s most striking laboratory
Chief Complaint result(s)?
Headache, photophobia, painful and stiff neck, nausea and 2. How do you explain this patient’s most striking laboratory
vomiting (5 to 6 episodes). result(s)?
3. What condition(s) does this patient’s laboratory and other
Past Medical History findings suggest?
Two years ago, the patient presented twice to the emergency 4. What are the principal complications found in this patient’s
department (ED) over a 2-week period with clinical signs and condition?
symptoms suggestive of meningitis. Laboratory investigation 5. What is(are) the most likely cause(s) of the principal com-
of her cerebrospinal fluid (CSF) showed decreased glucose plications found in this patients condition?
and increased total protein, findings suggestive of bacterial 6. Which laboratory and non-laboratory test(s) are appropri-
meningitis; however, the CSF cell count was low and no bac- ate to order on this patient and why?
terial growth was obtained. Antibiotics were administered 7. What is the most appropriate treatment for this patient?
and the patient was discharged.
Possible Answers:
Drug History 1. Markedly increased CSF cell count, total protein, albumin,
No current history of any medications, drugs of abuse, or and IgG values; markedly decreased glucose concentration;
therapeutic drugs. No other drug history was noted apart markedly abnormal CSF indices; and negative tests for bacte-
from Coproxamol and antibiotics (Augmentin, gentamicin, rial organisms.
bezylpenicillin, and chloramphenicol) taken at various times
following her earlier admission to the ED. 2. The markedly increased CSF nucleated cell count (89%
354 polymorphonuclear leukocytes), when coupled with the pa-
Physical Examination tient’s presenting signs (meningeal inflammation) and symp-
The patient was febrile (temperature, 38C), mildly toms (headache, recurrent febrile attacks), are suggestive of
bradycardic (pulse: 80 bpm), borderline hypertensive (blood Mollaret’s meningitis. The increased CSF total protein and
pressure, 140/80 mmHg), with neck-stiffness, negative decreased glucose concentrations are consistent with a bacte-
Kernig’s sign (a sign of meningitis in which the patient, in rial meningitis; however, microbiological analysis failed to
the sitting posture or when lying with the thigh flexed upon isolate or identify a causative organism. Moreover, the CSF
the abdomen, can- not completely extend the leg), and no total protein concentration was markedly higher than that
photophobia.
laboratorymedicine> may 2003> number 5> volume 34 ©
Headache case studies
Case study [chemistry | microbiology] Principal Laboratory Findings
Downloaded from https://academic.oup.com/labmed/article/34/5/354/2657287 by guest on 02 October 2021
[T1]
Recurrent Headache
and Febrile Attacks Results of Other Diagnostic Procedures
A computed tomography (CT) scan of the brain was
in a Young Woman performed and showed a small calcified lesion to the left of
Ibrahim A. Hashim, PhD, DABCC,1 Mohammed Nabil Richi, the torculax in the posterior fossa which looked like an old
MD, FRCPI2 lesion (possibly an old granuloma, tuberculous or listerial
1 infection, or a residue of some incident in childhood or in-
Departments of Pathology, and 2Internal Medicine, King Khalid
National Guard Hospital, Jeddah, Kingdom of Saudi Arabia fancy) of no current clinical significance. Overall, CT find-
DOI: 10.1309/Y5PTWN3AR6GVRW6T
ings on this admission were similar to those obtained during
her first presentation to the ED 2 years ago. There was no
evidence of hydrocephalus, abscesses, or cysts.
Patient
24-year-old woman. Questions:
1. What is(are) this patient’s most striking laboratory
Chief Complaint result(s)?
Headache, photophobia, painful and stiff neck, nausea and 2. How do you explain this patient’s most striking laboratory
vomiting (5 to 6 episodes). result(s)?
3. What condition(s) does this patient’s laboratory and other
Past Medical History findings suggest?
Two years ago, the patient presented twice to the emergency 4. What are the principal complications found in this patient’s
department (ED) over a 2-week period with clinical signs and condition?
symptoms suggestive of meningitis. Laboratory investigation 5. What is(are) the most likely cause(s) of the principal com-
of her cerebrospinal fluid (CSF) showed decreased glucose plications found in this patients condition?
and increased total protein, findings suggestive of bacterial 6. Which laboratory and non-laboratory test(s) are appropri-
meningitis; however, the CSF cell count was low and no bac- ate to order on this patient and why?
terial growth was obtained. Antibiotics were administered 7. What is the most appropriate treatment for this patient?
and the patient was discharged.
Possible Answers:
Drug History 1. Markedly increased CSF cell count, total protein, albumin,
No current history of any medications, drugs of abuse, or and IgG values; markedly decreased glucose concentration;
therapeutic drugs. No other drug history was noted apart markedly abnormal CSF indices; and negative tests for bacte-
from Coproxamol and antibiotics (Augmentin, gentamicin, rial organisms.
bezylpenicillin, and chloramphenicol) taken at various times
following her earlier admission to the ED. 2. The markedly increased CSF nucleated cell count (89%
354 polymorphonuclear leukocytes), when coupled with the pa-
Physical Examination tient’s presenting signs (meningeal inflammation) and symp-
The patient was febrile (temperature, 38C), mildly toms (headache, recurrent febrile attacks), are suggestive of
bradycardic (pulse: 80 bpm), borderline hypertensive (blood Mollaret’s meningitis. The increased CSF total protein and
pressure, 140/80 mmHg), with neck-stiffness, negative decreased glucose concentrations are consistent with a bacte-
Kernig’s sign (a sign of meningitis in which the patient, in rial meningitis; however, microbiological analysis failed to
the sitting posture or when lying with the thigh flexed upon isolate or identify a causative organism. Moreover, the CSF
the abdomen, can- not completely extend the leg), and no total protein concentration was markedly higher than that
photophobia.
laboratorymedicine> may 2003> number 5> volume 34 ©
