Table 1 Initial hypoglycaemia screen and CSF results
Parameter | Patient | Normal Range |
|---|---|---|
Glucose | 1.9 mmol/L | > 2.6 mmol/L |
Insulin | < 0.4mIU/L | 2.6–24.9mIU/L |
B-hydroxybutyrate | 6.37 mmol/L | 0.0–0.27 mmol/L |
Free fatty acids | 2.4 mEq/L | 0.0–0.6 mEq/L |
Cortisol | < 30 nmol/L | > 400 nmol/L |
Growth hormone | 14.6ug/L | > 5ug/L |
Ammonia | 44umol/L | 0.0-70umol/L |
Pyruvate | 0.06 mol/L | 0.0–0.18 mol/L |
Amino acids | Not suggestive of metabolic disease | |
CSF 1: Initial presentation | WCC < 1, RBC < 1 0% polymorphonuclear cells, 5% lymphocytes, 1% monocytes Protein 0.23, glucose 2.6 No growth, viral PCR negative | |
CSF 2: Eight days following presentation | WCC 2, RBC 22 8% polymorphonuclear cells, 53% lymphocytes, 39% monocytes Protein 0.23, glucose 2.8 No growth | |
CSF 3: Three months following presentation | WCC 1, RBC < 1 Insufficient cells for differential Protein 0.28, glucose 2.9 No growth Borderline raised neopterin (31.25 nmol/L), normal amino acids, CSF IgG < 4 mg/L, Serum IgG 1.9 g/L, CSF/serum albumin index 3.3. Matching oligoclonal IgG bands present in CSF and serum | |