A 63-year-old man is brought to the emergency department because of fever and confusion that have progressively worsened over the past 3 days. He has neck stiffness. The patient's condition quickly deteriorates, and he dies in the hospital despite appropriate treatment. Autopsy of the brain shows a diffuse gelatinous exudate covering the base of the brain. Cut sections of the brain show marked ventriculomegaly and frontal lobe infarcts but no intraparenchymal mass lesions. Which of the following is the most likely diagnosis?

Question

A 63-year-old man is brought to the emergency department because of fever and confusion that have progressively worsened over the past 3 days. He has neck stiffness.   The patient's condition quickly deteriorates, and he dies in the hospital despite appropriate treatment.  Autopsy of the brain shows a diffuse gelatinous exudate covering the base of the brain.  Cut sections of the brain show marked ventriculomegaly and frontal lobe infarcts but no intraparenchymal mass lesions.  Which of the following is the most likely diagnosis?

Quizplus · Accepted Answer

Eductional Objective: Tuberculous (TB) meningitis is characterized by formation of a thick, gelatinous exudate in the base of the brain; cerebral vasculitis; and hydrocephalus.  It frequently presents with subacute, slowly progressive nausea, vomiting, fever, cranial nerve deficits, and strokes.

A 63-Year-Old Man Is Brought to the Emergency Department Because