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## Patient's Clinical report summary: 
In the clinical report, the protein levels in the cerebrospinal fluid (CSF) are reported as 36.80 mg/dL, which is within the normal reference range of 20-45 mg/dL. However, the absence of lymphocytes in the CSF might be noteworthy, depending on the clinical context, as lymphocytes typically play a role in the immune response within the CSF. All other results, including chloride and sugar levels, as well as physical and additional microscopic examinations (Total W.B.C. count, presence of polymorphs, and absence of red blood cells) are within normal limits. The report indicates no significant abnormalities in the cerebrospinal fluid characteristics examined.. 
  
**end of patient's clinical report** 

  

## User Query: what could be the possible diagnosis? 
  
**end of user query** 

  

## Clinical findings from a knowledge base: 
  

CSF Examination Cerebrospinal fluid (CSF) examination should be performed in all patients with suspected viral encephalitis unless contraindicated by the presence of severely increased intracranial pressure (ICP). Ideally at least 20 mL should be collected with 5-10 mL stored frozen for later studies as needed. The characteristic CSF profile is indistinguishable from that of viral meningitis and typically consists of a lymphocytic pleocytosis, a mildly elevated protein concentration, and a normal glucose concentration. A CSF pleocytosis (>5 cells/pL) occurs in >95% of immunocompetent patients with documented viral encephalitis. In rare cases, a pleocytosis may be absent on the initial lumbar puncture (LP) but present on subsequent LPs. Patients who are severely immunocompromised by HIV infection, glucocorticoid or other immunosuppressant drugs, chemotherapy, or lymphoretic- ular malignancies may fail to mount a CSF inflammatory response. CSF cell counts exceed 500/pL in only about 10%. 

(CSF) for organisms including herpes simplex virus (especially type 2), Cryptococcus neoformans, and Mycobacterium tuberculosis. In central nervous system tuberculosis, the CSF typically has elevated protein and lowered glucose concentrations, with a mononuclear pleocytosis. CSF protein levels range from 100 to 500 mg/dL in most patients, the CSF glucose concentration is <45 mg/dL in 80% of cases, and the usual CSF cell count is between 100 and 500 cells/L.. 

Analysis of Cerebrospinal Fluid (CSF) Assessment of CSF is critical for patients with suspected meningitis or encephalitis. An opening pressure should always be recorded, and fluid should routinely be sent for cell counts, Gram’s stain and culture, and determination of glucose and protein levels. A CSF Grams stain typically requires >10° bacteria/mL for reliable positivity; its specificity approaches 100%. Table 115-4 lists the typical CSF profiles for various infec- tions. In general, CSF with lymphocytic pleocytosis and a low glucose concentration suggests either infection (e.g., with Listeria, M. tuberculosis, or a fungus) or a noninfectious disorder (e.g., neo- plastic meningitis, sarcoidosis). Bacterial antigen tests of CSF (e.g., latex agglutination tests for Haemophilus influenzae type b, group B Streptococcus, S. pneumoniae, and Neisseria meningitidis) are not recommended for screening, given that these tests are no more sensitive than Gram’s stain; however, these assays can. 

Laboratory Features CSF findings are distinctive, consisting of an elevated CSF protein level (1-10 g/L [100-1000 mg/dL]) without accompanying pleocytosis. The CSF is often normal when symptoms have been present for <48 h; by the end of the first week, the level of protein is usually elevated. A transient increase in the CSF white cell count (10-100/j1L) occurs on occasion in otherwise typical GBS; however, a sustained CSF pleocytosis suggests an alternative diag- nosis (viral myelitis) or a concurrent diagnosis such as unrecognized HIV infection, leukemia or lymphoma with infiltration of nerves, or neurosarcoidosis. Edx features are mild or absent in the early stages of GBS and lag behind the clinical evolution. In AIDP, the earliest fea- tures are prolonged F-wave latencies, prolonged distal latencies, and reduced amplitudes of compound muscle action potentials (CMAPs), probably owing to the predilection for involvement of nerve roots and distal motor nerve terminals early in the. 

AND
CSF with a total white cell count <50 cells/uL) (with or without CSF protein elevation above laboratory normal value)
OR
Nerve conduction studies are normal, OR indicate involvement of sensory nerves only
AND No alterations in consciousness or corticospinal tract signs AND Absence of identified alternative diagnosis Level 3 of diagnostic certainty
Bilateral ophthalmoparesis and bilateral reduced or absent tendon reflexes and ataxia
AND Absence of limb weakness AND
Monophasic illness pattern and interval between onset and nadir of weakness between 12 h and 28 days and subsequent clinical plateau
AND
No alterations in consciousness or corticospinal tract signs AND
Absence of identified alternative diagnosis
 
Abbreviation: CSF, cerebrospinal fluid.. 
  

**end of clinical findings knowledge base** 



The clinical report indicates some abnormalities in the blood indices and platelet count. The Packed Cell Volume (PCV) is elevated at 57.5% compared to the reference range of 40-50%, which is high. The Hemoglobin (Hb) level is slightly low at 12.5 g/dL, against a reference of 13.0-17.0 g/dL. Furthermore, the platelet count is on the borderline high end, at 150,000 cu/mm, where the upper reference limit is 410,000 cu/mm. These results suggest the possibility of an underlying health issue, and the report recommends further confirmation for anemia. This information could be useful in guiding further diagnostic and therapeutic measures.