Which CSF profile is most consistent with viral meningitis?

• A. Increased opening pressure with neutrophilic predominance and low glucose
• B. Normal opening pressure with lymphocytic pleocytosis, normal glucose, and normal to mildly elevated protein
• C. Decreased opening pressure with lymphocytic predominance and low protein
• D. Normal opening pressure with neutrophilic predominance and high glucose

Answer: (B)

Viral meningitis typically shows a CSF pattern with lymphocytic predominance, normal glucose, and normal to mildly elevated protein, with opening pressure usually normal. This reflects a viral rather than bacterial process, where the immune response brings lymphocytes into the CSF, glucose is preserved because viruses don’t consume it like bacteria do, and protein is only mildly increased from inflammation. The described profile—normal opening pressure, lymphocytic pleocytosis, normal glucose, and normal to mildly elevated protein—fits viral meningitis best.