Diagnostic Dilemma
I had a call today from a friend of mine - patient with 9 months history of head ache and vomiting presenting with "meningism". (Clinical Signs of Meningitis). CSF (Fluid surrounding the brain) studies normal. the consultant was not sure what he was dealing with. to add to this, the patient was HIV positive.... Diagnostic dilemma's are not unusual in Medicine. Dilemma occurs when clinical signs point to one diagnosis but investigations do not support the same. With a pre-existing illness some of the dilemma are more complex. you need second opinion from more experienced clinicians to sort out dilemma like these! And that was the expectation from me - but at the end of the consult all I could give was a few differential diagnosis - could be 1 - Crypto 2 TBM 3 Toxo 4 Lymphoma etc.....A final diagnosis could only be possible by identifying the "fungus" or Bacteria" - the root cause....