A 13-year-old female presents with lethargy, fever, severe headache, and a stiff neck. On examination, a unilateral fixed, dilated pupil and papilledema is noted. Each of the following would be appropriate in initial management, EXCEPT:
This case most likely represents an adolescent with meningitis who has developed increased intracranial pressure. Intubation and hyperventilation is indicated immediately. Hyperventilation is the most appropriate immediate, non-surgical treatment of intracranial hypeension. By hyperventilating this patient you will decrease the pCO2 resulting in vasoconstriction of the central nervous system. Decreasing the pCO2 5 to 10 mm Hg will decrease intracranial pressure 25 to 30%. Administering antibiotics, preferably after blood cultures are obtained, is appropriate. Obtaining computerized tomography of the head may reveal intracranial lesions, which require additional therapy Ref: Ropper A.H., Samuels M.A. (2009). Chapter 2. Special Techniques for Neurologic Diagnosis. In A.H. Ropper, M.A. Samuels (Eds), Adams and Victor's Principles of Neurology, 9e.
Intubation and hyperventilation
Mannitol administered intravenously
Computerized tomography of the head
Lumbar puncture