Tag Archives: Meningitis

8/11 Morning Report w/ TK and Dr. Robbins: Bilateral hearing loss and meningitis bugs

A middle aged female recently seen in ED x 2 for chest wall pain, presents with one day of bilateral hearing loss, headache, and vomiting. She was initially afebrile but subsequently developed a mild fever. We discussed a broad differential including SAH and infection; she was ultimately diagnosed with strep agalactie (GBS) meningitis based on blood cultures and results of an LP!

Teaching points:

Interpreting an LP with many RBCs:

– How many WBCs is too many?

*Here is a nifty calculator to help you adjust your WBCs for a suspected traumatic tap

https://www.uptodate.com/contents/calculator-adjusted-cerebrospinal-fluid-white-blood-cell-count-in-the-presence-of-red-blood-cells?source=see_link&utdPopup=true

-How can we distinguish SAH from traumatic tap?

*Clearing of RBCs from tubes 1 to 4 is helpful in excluding SAH ONLY if there are substantial RBCs in tube 1 and none in tube 4

*A Xanthrochromic supernatant is very suggestive of SAH

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