335.A 35-year-old woman presents to the ED for the second time. She is
complaining of fever, neck stiffness, and photophobia. She was seen in your
ED 2 days ago for the same symptoms. At that time, she had a normal neu-
rologic examination, was otherwise well-appearing, and underwent diag-
nostic LP. The results of her CSF analysis were as follows:
Glucose 82 mg/dL
Protein 60 mg/dL
WBC 150/ L (98% lymphocytes)
Gram stain No organisms seenThe patient was sent home after a period of observation with presumed
viral meningitis. She was told to return if her symptoms were not better in
48 hours. Since then, her fever increased (100.4°F–102.2°F). What is the
next most appropriate step in management?
a. Administration of acyclovir
b. Aggressive antipyretic therapy and observation
c. CT scan of the sinuses
d. CT of the head and, if no contraindication, repeat LP
e. Viral cultures and polymerase chain reaction (PCR) from previously obtained
CSF
336.A 68-year-old man presents to the ED complaining of a daily headache
for almost a month. He describes the headache as being dull, difficult to
localize, most intense in the morning, and abating in the early afternoon. He
also noticed progressive weakness of his right upper and lower extremity.
Which of the following headache syndromes are the signs and symptoms
most consistent with?
a. Headache caused by a mass lesion
b. Cluster headache
c. Tension-type headache
d. Headache from intracranial hypertension
e. Waking or morning migraine
352 Emergency Medicine