Headache. A Good Diagnosis Thanks To Laboratory Medicine

Clinical Summary

A 21-year-old man started acutely with a severe headache, occasionally increasing in intensity, especially in the occipital region, accompanied by lightheadedness and fever (37.4 degrees Celsius) and a moderate feeling of nausea. The patient had been surfing in the days prior to the clinical picture.
The Physical examination showed the patient to be generally affected, conscious and oriented. There were no motor deficits. Examination findings included moderate stiff neck.

Laboratory data

Moderate leukocytosis, with normal platelet and haemoglobin levels. Renal function was normal. Urine and blood cultures were negative.

The cerebrospinal fluid study showed leukocytosis (450 /microlitre), with less than 50% polymorphonuclear, glycaemia of 60 mg/dl, protein <100 mg/dl, and negative Gram stain.

The Polymerase Chain Reaction (PCR) study for different viruses and bacterias, including Parvovirus B19 and Nile Virus, was negative, as shown in the panel below:

Clinical Evolution

The patient remained for three days with general malaise, with a headache that he sometimes described as if someone was kicking him in the occipital region, nausea, and fever. The condition was treated symptomatically, with antibiotics and acyclovir, until the final results of the cultures. The patient recovered completely without sequelae

Final diagnosis

Aseptic meningitis of viral origin.
A specific PCR determination detected the virus responsible for the infection.

We provide the following QUIZZ to help those who want to suggest the aetiology.

Final Comment

The knowledge of the viral pathology, together with an established protocol to perform a panel of frequent viruses, and the PCR technique, allowed the diagnosis to be made in a short time and with precision. Although the treatment is symptomatic, the knowledge of which agent is causing the disease is key to establishing the follow-up of the patient.

If you want to know the aetiological agent, we present it in the following review HERE

Author: Dr. Lorenzo Alonso Carrión

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