A 62-year-old man with history of pituitary macroadenoma treated with transsphenoidal surgery 3 months ago presents with acute confusion, severe frontal headache, and nuchal rigidity. Vital signs: BP 108/62, HR 102, RR 18, Temp 38.2°C, SpO2 98% on room air. Serum sodium 118 mEq/L. CSF analysis reveals pleocytosis with elevated protein and low glucose. Gram stain and bacterial cultures are pending. He denies photophobia. Which diagnosis best explains his clinical presentation?
- A)Central pontine myelinolysis from rapid sodium correction
- B)Acute adrenal crisis from postoperative cortisol deficiency
- C)Recurrent pituitary apoplexy
- D)Postoperative meningitis with secondary SIADHGABARITO
- E)Diabetes insipidus with dehydration-induced hypernatremia
Explicação
Post-transsphenoidal surgery meningitis is a serious complication (0.5-2% incidence) presenting with classic meningeal signs and CSF pleocytosis. The severe hyponatremia reflects concurrent SIADH, common with CNS infection. This requires urgent IV antibiotics ... Ver explicação completa e trilha adaptativa →