Infectious diseases: tuberculous meningitis: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Infectious diseases: tuberculous meningitis

Sample item

A 24-year-old man has had 2 weeks of headache, low-grade fever and vomiting, and now has a right sixth nerve palsy. CSF shows 150 cells/mm3 (85% lymphocytes), protein 220 mg/dL and glucose 25 mg/dL with a simultaneous blood glucose of 100 mg/dL. Which imaging finding is most expected?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Basal meningeal enhancement with hydrocephalus

Subacute meningitis with lymphocytic pleocytosis, high protein and low CSF glucose suggests tuberculous meningitis. The inflammatory exudate is thickest at the base of the brain, causing cranial nerve palsies, hydrocephalus and infarcts of the basal ganglia from vasculitis. MRI shows basal meningeal enhancement and hydrocephalus.

Option by option

  • A. Cerebral venous sinus thrombosis with a delta sign

    Venous sinus thrombosis causes headache and infarcts but not a low CSF glucose.

  • B. Temporal lobe haemorrhagic necrosis

    Temporal necrosis is characteristic of herpes simplex encephalitis, which has normal CSF glucose.

  • C. Ring-enhancing lesion with a central scolex

    A cyst with a scolex is neurocysticercosis, which does not usually produce this CSF picture.

  • D. Basal meningeal enhancement with hydrocephalus (correct)

    A basal exudate explains the cranial neuropathy and communicating hydrocephalus.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is D, Basal meningeal enhancement with hydrocephalus. Subacute meningitis with lymphocytic pleocytosis, high protein and low CSF glucose suggests tuberculous meningitis.

Why is "Cerebral venous sinus thrombosis with a delta sign" not the answer?

Venous sinus thrombosis causes headache and infarcts but not a low CSF glucose.

Why is "Temporal lobe haemorrhagic necrosis" not the answer?

Temporal necrosis is characteristic of herpes simplex encephalitis, which has normal CSF glucose.

Why is "Ring-enhancing lesion with a central scolex" not the answer?

A cyst with a scolex is neurocysticercosis, which does not usually produce this CSF picture.

What concept does this question test?

It tests Infectious diseases: tuberculous meningitis in General Medicine. The inflammatory exudate is thickest at the base of the brain, causing cranial nerve palsies, hydrocephalus and infarcts of the basal ganglia from vasculitis. MRI shows basal meningeal enhancement and hydrocephalus.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Infectious diseases: tuberculous meningitis?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.