A 46-year-old man is brought to the emergency department because of worsening confusion and weakness in his right arm and leg for 2 days. He has also had fever and headache that began 5 days ago. He has hypertension and type 2 diabetes mellitus. Current medications include metformin and lisinopril. His temperature is 39.3°C (102.7°F), pulse is 103/min, and blood pressure is 128/78 mm Hg. He is confused and agitated. He is not oriented to person, place, or time. Neurologic examination shows nuchal rigidity. Muscle strength is 3/5 on the right upper and lower extremity but normal on the left side. His speech is incoherent. An ECG shows no abnormalities. MRI of the brain shows swelling of the temporal lobes. CSF analysis is most likely to reveal which of the following?

Question

A 46-year-old man is brought to the emergency department because of worsening confusion and weakness in his right arm and leg for 2 days. He has also had fever and headache that began 5 days ago. He has hypertension and type 2 diabetes mellitus. Current medications include metformin and lisinopril. His temperature is 39.3°C (102.7°F), pulse is 103/min, and blood pressure is 128/78 mm Hg. He is confused and agitated. He is not oriented to person, place, or time. Neurologic examination shows nuchal rigidity. Muscle strength is 3/5 on the right upper and lower extremity but normal on the left side. His speech is incoherent. An ECG shows no abnormalities. MRI of the brain shows swelling of the temporal lobes.  CSF analysis is most likely to reveal which of the following?

Quizplus · Accepted Answer

Eductional Objective: Viral infections of the central nervous system are usually characterized by an elevated white blood cell count with a lymphocytic predominance, normal glucose, and elevated (or normal) protein.  Patients with herpes encephalitis also usually have elevated erythrocytes in the cerebrospinal fluid due to hemorrhagic inflammation of the temporal lobes.

A 46-Year-Old Man Is Brought to the Emergency Department Because