Welcome to emergency medicine cases.com. I'm your host, Dr. Anton Hellman, bringing you Canada's brightest minds in emergency medicine from EMC Studios in Toronto.

So we're back with Dr. Jordan Chanken and Dr. Jamie Blicker on the second part of the Procedures

episode, Pearls and Pitfalls, Tips and Tricks. And we're going to jump right into another case.

This case is that of a 54-year-old otherwise healthy woman who presents to your ED with a two-day

history of gradual onset,

diffuse headache, and generalized weakness.

Her husband reports that she's been unusually confused and has had difficulty ambulating

for the past few hours, prompting him to bring her to the ED.

Review of systems is otherwise negative.

On exam in the ED, her vital signs are normal, except for a heart

rate of 105 and a temp of 38.1 degrees. Her GCS is 14, pupils are equal and reactive, Fundai are

difficult to assess, and her neck is supple. She has a negative Kernig and Brzezinski's, but a positive

jolt accentuation of her headache.

She's able to ambulate, but with some difficulty due to diffuse weakness.

She has no pronator drift.

Cerebellar testing is normal.

Power is four out of five throughout.

Sensation is intact and reflexes are normal.

So, Dr. Chanken, you've got this patient with a headache, confusion, fever, and jolt

accentuation.

Your working diagnosis is bacterial meningitis and you wonder whether or not she needs

a CT of her head before performing an LP.

...