Monday April 26, 2010


Q: 42 year male with no previous history known is brought to ER with mental status change, fever and nuchal rigidity. CT scan is not much of information. ER doc performed lumbar punture and transferred patient to ICU. You get STAT call from lab that there is a spiderweb clot in the collected CSF. What does it mean?


Answer: A spiderweb clot in the collected CSF is characteristic of TB meningitis though not always present.

The CSF usually has a high protein, low glucose and a increase lymphocytes. Acid-fast bacilli commonly grown in culture but the culture of TB from CSF takes about two weeks, and therefore the majority of patients with TB meningitis are started on treatment before the diagnosis is confirmed.