**Question:** A 25 year old lady presented with fever of 1 month duration, ataxia and head ache. Brain imaging showed dilated ventricles with basal exudates. Which among the following is the most likely CSF finding?

A. Increased protein
B. Increased glucose
C. Increased cells
D. Normal findings

**Core Concept:** The presentation of the patient includes fever, ataxia, and headaches, which are suggestive of a central nervous system (CNS) infection. Brain imaging demonstrates dilated ventricles with basal exudates, which further supports the suspicion of a CNS infection.

**Why the Correct Answer is Right:** The correct answer is **C. Increased cells**. In the context of a CNS infection, the increased number of cells in cerebrospinal fluid (CSF) indicates the presence of inflammation or infection. The increased protein (option A) and glucose (option B) levels could be seen in various conditions, not just CNS infections. Normal CSF findings (option D) are less likely in a patient with these symptoms and imaging findings.

**Why Each Wrong Option is Incorrect:**

A. Increased protein: CSF protein can increase in various conditions, not just CNS infections. Differentiating between increased protein due to infection, inflammation, or trauma is crucial to accurately diagnose the cause.

B. Increased glucose: While a decrease in glucose levels is a characteristic feature of CNS infections, a normal glucose level does not completely rule out the diagnosis. Increased glucose can occur in other conditions like lymphoma, leukemia, and meningitis.

**Clinical Pearl:**

It is essential to consider a differential diagnosis for CNS infections, including meningitis or encephalitis, when presented with the described symptoms and imaging findings. A combination of increased cell count, protein, and lactate levels is more indicative of a CNS infection, while a normal CSF finding is less likely. Assessing the cause of increased protein and glucose levels, as well as lactate levels, is critical to differentiate between various conditions and make an accurate diagnosis.