A young woman with headache and vomiting

• Published in: BMJ (Online) Vol. 364; p. l216
• Main Authors: Dobson, Gareth M, Robson, Craig H, Williams, John, Mukerji, Nitin
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 30-01-2019
• Subjects: Adult; Antitubercular Agents - therapeutic use; Biopsy; Blood; Brain - diagnostic imaging; Brain - microbiology; C-reactive protein; Cell culture; Cerebrospinal fluid; Craniotomy - methods; Diagnosis, Differential; Drug dosages; Drug resistance; Female; Fever; Glucocorticoids - therapeutic use; Headache; Headache - etiology; Headaches; Hemoglobin; Humans; Infections; Magnetic Resonance Imaging; Medical imaging; Meningitis; Mycobacterium tuberculosis - isolation & purification; Nervous system; Neutrophilia; NMR; Nuclear magnetic resonance; Pathogenesis; Polymerase chain reaction; Risk factors; Tissue culture; Tuberculosis; Tuberculosis, Central Nervous System - diagnosis; Tuberculosis, Central Nervous System - drug therapy; Vomiting; Vomiting - etiology; Womens health; United Kingdom > UK
• ISSN: 0959-8138; 1756-1833
• DOI: 10.1136/bmj.l216

Blood tests on admission were suggestive of mild neutrophilia: haemoglobin was 111 g/L (reference range 115-160), white blood cell count was 11.3×109/l (4-11), neutrophil count 9.6×109/l (2-7.5) and C reactive protein was <5 mg/L. If lumbar puncture is contraindicated, and therefore cerebrospinal fluid cannot be obtained, or if the cerebrospinal fluid cannot confirm diagnosis of TB, then a biopsy of the lesion with tissue culture and polymerase chain reaction may be performed. Generic features of raised intracranial pressure, such as headache, visual disturbance, and vomiting, may be present alongside systemic features such as fever and/or weight loss.