iFor the differential diagnosis, we have bacterial meningitis, viral meningitis, fungal meningitis,

encephalitis, and intracranial mass lesion. These diseases all exhibit fever, headache, seizure,
lethargy, tachycardia, and postictal confusion. They also exhibit positive Kernig’s sign and
brudzinski’s sign except for encephalitis. As discussed by (name), Kernig's sign and
Brudzinski's sign are indicative of meningeal irritation and are commonly associated with
meningitis. However, they can also be present in the context of an intracranial mass lesion,
such as a brain tumor or abscess. This is because an intracranial mass can cause increased
intracranial pressure, leading to irritation and inflammation of the meninges.

Both bacterial meningitis exhibit high opening intracranial pressure.Then the intracranial
pressure for viral meningitis is typically normal due to the self-limiting nature of the condition,
which does not cause significant inflammation and swelling in the brain and meninges as seen
in bacterial meningitis.As for Encephalitis,which is an inflammation of the brain parenchyma,
the opening pressure may vary depending on the underlying cause, severity, and other factors.
Opening pressure for fungal meningitis may vary as well.

Bacterial meningitis, viral meningitis, and encephalitis have high cell count in CSF. In bacterial
meningitis, the white blood cell (WBC) count in the cerebrospinal fluid (CSF) is usually elevated,
often greater than 1000 cells/mm3, with a predominance of neutrophils. For viral meningitis, the
CSF WBC count is typically lower than in bacterial meningitis, with a lymphocytic predominance.
In encephalitis, the CSF WBC count is slightly elevated, with a lymphocytic predominance. For
intracranial mass lesions, the cell count in the cerebrospinal fluid (CSF) can vary widely,
depending on the underlying cause and the degree of inflammation. A mild lymphocytic
pleocytosis is not uncommon, but in some cases, the cell count may be normal or even
elevated, with a predominance of neutrophils. And then, the variable cell count in fungal
meningitis can be attributed to the diverse nature of the underlying conditions and the host
response.

Bacterial meningitis, Fungal meningitis, Encephalitis, and intracranial mass lesion exhibit high
Protein count in CSF except for Viral meningitis, which is variable.

Both Bacterial and Fungal meningitis cause low glucose count, which will be explained later
noh. As for viral meningitis, encephalitis, and intracranial mass lesion has normal glucose count
and the latter can be varying.

According to harrison’s no 60% in bacterial meningitis has positive gram stain result but, in our
case, it was said that it was gram negative coccobacilli. Gram negative result is also seen in
viral meningitis and encephalitis, while fungal encephalitis is rarely positive and as for for
intracranial mass lesion can be varying.

The patient's diagnosis is Acute Bacterial Meningitis, which is likely secondary to the gum
infection. Acute Bacterial Meningitis, such as the one in this case, is considered an acute
condition because of the rapid onset and progression of symptoms. The infection can cause the
tissues surrounding the brain to swell, leading to potentially life-threatening complications like
paralysis, stroke, and even death if left untreated. The symptoms, such as sudden onset of
fever, headache, and seizure, as well as the laboratory results, including the presence of gram-
negative coccobacilli in the cerebrospinal fluid, suggest that this is a serious and acute bacterial
infection