A 38-year-old woman presents to the emergency department with fever, severe headache and neck stiffness. She is confused but maintaining her airway;

Question

A 38-year-old woman presents to the emergency department with fever, severe headache and neck stiffness. She is confused but maintaining her airway; her GCS is 14, blood pressure is 116/72 mmHg and capillary glucose is 6.1 mmol/L. During assessment she develops new right arm weakness. She has no rash or known antibiotic allergy. Blood sampling, intravenous access and monitoring can be established immediately. Which investigation and treatment sequence is most appropriate?

Accepted Answer

Take blood cultures, give intravenous ceftriaxone and dexamethasone, perform CT head after stabilisation, then perform lumbar puncture once the weakness resolves.

Answer

Take blood cultures, perform CT head, give intravenous ceftriaxone and dexamethasone, then perform lumbar puncture once the weakness resolves.

Answer

Take blood cultures, perform lumbar puncture, give intravenous ceftriaxone and dexamethasone, then perform CT head if the weakness persists.

Answer

Take blood cultures, give intravenous ceftriaxone and dexamethasone, perform CT head, then perform lumbar puncture if no mass lesion is seen.

Answer

Take blood cultures, give intravenous ceftriaxone, perform CT head after stabilisation, then give dexamethasone if lumbar puncture confirms bacterial meningitis.

Strongly suspected bacterial meningitis with a new focal neurological deficit — MRCEM SBA MCQ