An 82-year-old previously healthy woman with a recent upper respiratory infection presents with generalized weakness, headache, and blurry vision. For the past 2 weeks she has had upper respiratory symptoms that started with a sore throat, nasal congestion, and excessive coughing. She went to her primary care doctor 4 days ago and was diagnosed with sinusitis. She was given a prescription for an antibiotic and took it for 2 days, then stopped. She thereafter had chills, lightheadedness, vomiting, blurry vision, general achiness, and a headache that started abruptly and has not gotten better since. Except for blurry vision, she has not had any other visual symptoms. The blurry vision remains when she closes either eye. She also has eye tenderness with movement and mild photosensitivity. She has no drug allergies. Exam findings include temperature of 102.5°F, nuchal rigidity, and sleepiness. Which of the following is the next most appropriate action in this case?
a. Get a brain MRI, then perform a lumbar puncture
b. Give the patient a prescription for oral azithromycin and let her go home
c. Immediately give intravenous ceftriaxone plus ampicillin
d. Immediately start intravenous acyclovir
e. Obtain cerebrospinal fluid and blood cultures and observe the patient until the results come back
the answer is below…