Case Study 14

The Student with Meningitis

Heather, a 22-year-old college senior, spends a semester as an

intern in Venezuela. Before coming home, she decides to see
some of the sights and travels around the country for 3 weeks.
Upon her return, she notices that she feels tired, her neck is
stiff, her head aches, and she has a slight fever. She tells her
roommate that she is going to lie down for a nap. Later that
evening when Heathers mother calls, her roommate has
difficulty waking her and notices that Heather seems to be
having trouble walking and talking. After realizing that Heather
has a fever, she takes Heather to the student health center. On
the way, Heather becomes nauseous and vomits.
While Heathers roommate is checking her in at the health
center, Heather becomes uncooperative and wants to leave. She
doesnt calm down until one of the aides comes out. After this,
Heather appears to relax and to fall asleep with her eyes open.
At this time, her roommate gives the nurse as complete a history
as possible, including information about Heathers recent trip to
Venezuela. In the examination room, the physician notes that
Heathers neck is rigid and she has difficulty moving her legs.
Her oral temperature is 104F, and her heart rate is 130
beats/min. During the examination, Heather vomits again and
begins to convulse. Suspecting meningitis or encephalitis, the
physician immediately orders a spinal tap and blood sampling
and starts intravenous antibiotics (ampicillin).
Results of the spinal tap and blood work are shown here.
CSF:
Leukocyte count = 20,000 cells/mL
Glucose = 18 mg/dL
Protein = 40 mg/dL
Diplococci present
Blood:
Glucose = 120 mg/dL
RBC count = 3.8 x 106/L
WBC count = 18,000/L
(In both the CSF and the blood, the majority of
leukocytes are neutrophils.)
Based on the results of these tests, Heather is diagnosed
with bacterial meningitis. The intravenous antibiotic treatment
is continued, but the antibiotic is changed to penicillin G, which
is more specific for pneumococcus. A CT scan of the head is
performed and shows no cerebral infarction and minimal
inflammation. Heather is also given intravenous fluid and an
antipyretic. When her parents arrive, they are told that Heather
should recover fully.

Based on this case study and other information in this

chapter, answer the following questions.
1.

Why does the physician suspect either meningitis or

encephalitis?

2.

If the diagnosis is in doubt, why are antibiotics

administered immediately?

3.

How do the results obtained from the spinal tap and blood
sample support the diagnosis? How do the results obtained
from the spinal tap rule out viral encephalitis?

4.

Other than meningitis or encephalitis, what conditions

could account for some or all of Heathers signs and
symptoms?

5.

Why is fluid and electrolyte replacement necessary?

6.

If inflammation of Heathers meninges had caused

compression of the brain, how would the ventricles appear
in the CT scan?

7.

Polio compromises respiratory function in some patients,

requiring the use of a mechanical ventilator. What happens
at the cellular level to cause these breathing problems?
Recall that virtually all cases of polio in the United States
now result from the polio vaccine itself. In light of this,
would you choose to have your child vaccinated against
polio? Why or why not?

8.

9.

Which type of glial cell do you think is responsible for the

scars that form in amyotrophic lateral sclerosis? Explain.

10. Al is brought into the emergency room after a motorcycle

accident. At the scene, he was found unconscious, with
numerous scrapes and bruises on the left side of his head
and swelling above his right ear. When he regains
consciousness 3 hours later, he complains of a headache
and appears dazed. His speech is slurred, and his pupils are
equal and reactive to light. Twenty-four hours later, all
signs appear normal. Which of the following is the most
likely diagnosis of Als condition?
a. mild concussion
b. massive subdural hematoma
c. severe concussion
d. meningitis
e. cerebral contusion

Selected Clinical Terms

apnea

Temporary cessation of breathing.

hematoma

A mass of clotted blood in the tissues; a bruise.

concussion An injury to the brain or other soft tissue

resulting from a violent blow or shaking.

hemiparesis Muscular weakness or partial paralysis on one

side of the body.

contusion An injury to the brain or other tissue that causes

subsurface hemorrhaging (bruising).

hemiplegia Complete paralysis of muscles on one side of the

body, usually indicating a cerebral lesion.

febrile

hypotension

Accompanied by fever.

Abnormally low blood pressure.