CASE 7: What to Order

Clinical History

HPI: 43 year old male presents with fevers and seizures.

Questions

1. What is your clinical differential diagnosis?

Answer

2. What is the role of imaging in this patient?

• The diagnosis of CNS infection is made clinically with the assistance of CSF analysis by lumbar puncture.
• Imaging can be helpful to initially evaluate for signs of increased intracranial pressure prior to LP
• Imaging can also be useful in monitoring the complications of CNS infection including abscess formation, hydrocephalus and venous/arterial thrombosis.
• Meningitis is a clinical diagnosis and patients with meningitis often will have normal imaging. Therefore imaging cannot be used to confirm or disprove the presence of meningitis.