Triage: x1 wk c/o numbness, weakness, to feet, legs, and arms, “prickly feeling” started from feet and going up, was sick x1 wk ago, dull pain to neck and back, , no trauma
History of Present Illness: 26-year-old male with 1 week of progressive weakness associate with pins-and-needles in arms and legs. Not generalized weakness it is his muscles in his arms and legs. In the last 2 days he started develop some upper and lower back discomfort. No trouble urinating, fever, injections or other complaints. Did get over a cold about a week or 2 ago and did get 3 unknown vaccines about 6 weeks ago
Vital Signs: T: 37.1 °C (Oral) HR: 92 (Peripheral) RR: 17 BP: 130/85 SpO2: 99%
Physical Exam: No focal weakness. Alert and oriented. No clonus but absent deep tendon reflexes. Somewhat funny gait. Difficulty with doing 10 lunges which he says would not be typically any difficulty for him
Initial Diagnostic Testing:
- CBC: normal WBC and other cell counts but there is 88% PMNs as well as toxic granulation noted on WBC morphology (if you don’t know what that means then CLICK HERE)
- Chem-7: normal as was CK
- Flu/Covid/RSV: normal
- Imaging: CT brain done 3 days ago normal
Given the above data, what is the most likely cause and next test/evaluation to obtain?
- A) CVA; get an MRI
- B) Meningitis; get an LP
- C) Tox: get a urine drug test and alcohol level
- D) None of the above
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ANSWER:
CASE CONCLUSION: CSF WBC = 1, CSF protein = 69