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Volume 357:197 July 12, 2007 Number 2
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Case 11-2007: Neck Pain, Weakness, and Cranial-Nerve Palsies

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by Greer, D. M.
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To the Editor: In the discussion of Case 11-2007, which involved a 59-year-old man with Lyme disease, Greer et al. (April 12 issue)1 did not consider the differential diagnosis of tubercular meningitis. In a patient with a long history of symptoms, the presence of multiple cranial-nerve palsies, a low neutrophil count, and high levels of protein and glucose in the cerebrospinal fluid, the possibility of a potentially curable mycobacterial infection should be considered.2 Although the patient had negative microbiologic findings, in adults with clinical tubercular meningitis, the acid-fast smear and mycobacterial culture of cerebrospinal fluid both have a low sensitivity . . . [Full Text of this Article]



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