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Tuberculous meningitis — SCE Neurology MCQ

Instant feedback + full explanation. One question, done properly.

HardCNS infectionsTuberculous meningitisSCE Neurology

A 46-year-old develops subacute fever, headache, tremulous ataxia, urinary retention and encephalopathy. CSF contains 180 lymphocytes/µL. MRI shows fine linear radial enhancement extending from the lateral ventricles through the white matter. Serum GFAP-IgG is weakly positive. Which result would most specifically secure the suspected diagnosis?

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Reveal the answer and explanation

Correct answer: A — GFAP-IgG detected in CSF by a validated cell-based assay

Explanation lettering: E = shown as C · C = shown as E

A is correct: the meningoencephalomyelitic phenotype and radial perivascular enhancement are characteristic of autoimmune GFAP astrocytopathy, and CSF GFAP-IgG is substantially more specific than an isolated low serum result. Repeating the same serum platform does not resolve compartment or assay-specificity concerns. Oligoclonal bands support inflammation but are not disease-specific. AQP4-IgG would redirect the diagnosis toward NMOSD, and serum GFAP concentration is a nonspecific injury biomarker rather than the defining autoantibody test.

Reference: Autoimmune glial fibrillary acidic protein astrocytopathy: a systematic review: https://pmc.ncbi.nlm.nih.gov/articles/PMC11235751/