7.3.2 Headache attributed to aseptic (non-infectious) meningitis

Identification: Sex/Age: Male, 35 years History: Pulmonary sarcoidosis diagnosed 6 months ago Medication: Methotrexate 15mg/week and prednisone 10mg/day Allergies: None known History of Present Illness (HPI): Main symptom: Severe headache for 4 days Pain characteristics: Location: Frontal and occipital Character: Pulsatile Intensity: 8/10 Course: Progressive Associated symptoms: Low-grade fever (38°C) Neck stiffness Nausea Moderate photophobia Physical/Neurological Examination: Meningeal signs positive: Neck stiffness (2 fingers distance) Positive Brudzinski's sign Neurological examination: No motor or sensory deficits Normal and symmetrical reflexes Isocoric, photoreactive pupils Mental status: Patient alert, but with mild irritability Complementary Examinations: Cerebrospinal fluid (CSF): Opening pressure: 22 cmH2O Appearance: Clear Cells: 80/mm3 (90% lymphocytes) Proteins: 65 mg/dL Glucose: 55 mg/dL (blood glucose 98 mg/dL) Cultures: Negative after 72h PCR for common pathogens: Negative Brain MRI: Mild leptomeningeal enhancement Inflammatory markers: CRP: 2.8 mg/dL ESR: 42 mm/h