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Tuberculous Meningitis Overview and Stages

This document discusses tuberculous meningitis (TBM), which is a severe form of central nervous system tuberculosis infection. It occurs more commonly in developing countries and can have high mortality if not properly diagnosed and treated. The document covers the epidemiology, pathogenesis, clinical features, diagnosis and treatment of TBM. It notes that TBM symptoms can range from low grade fever and headache to more advanced stages involving cranial nerve palsies, neurological deficits, and altered mental status.

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344 views11 pages

Tuberculous Meningitis Overview and Stages

This document discusses tuberculous meningitis (TBM), which is a severe form of central nervous system tuberculosis infection. It occurs more commonly in developing countries and can have high mortality if not properly diagnosed and treated. The document covers the epidemiology, pathogenesis, clinical features, diagnosis and treatment of TBM. It notes that TBM symptoms can range from low grade fever and headache to more advanced stages involving cranial nerve palsies, neurological deficits, and altered mental status.

Uploaded by

zuhri
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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TUBERCULOUS MENINGITIS

Susi Aulina
Neurology Departement
Faculty Of Medicine Hasanuddin University
outline
• Introduction
• Epidemiology
• Phatogenesis
• Clinical fetures of Tuberculous Meningitis
• Diagnosis of Tuberculous Meningitis
- Cerebrospinal fluid is Tuberculous Meningitis
- Neuroimaging is Tuberculous Meningitis
• Treatment
-Anti microbial
-Controlling the host inflamatory response
-Supportive Therapy
• Prognosis
• Case Ilustrasions
INTRODUCTION
Central Nervous System Tuberculous (CNS TB)
• 3 entities : 1. Tuberculous Meningitis (TBM)
2. Intracranial tuberculoma
3. Spinal tuberculous arachnoiditis
Exist in countries with a high incidence of TB
Occurs equally in both sexes, at any age
INTRODUCTION
• Tuberculous Meningitis (TBM)
• Is the most severe form of My Tuberculous infection
• Usually found to be assiciated with primary TB infection particulary in
the lungs → transmitted to menings and brain (tuberculous
bacterimia)
• Morbidity and mortality are high if not diagnosed and treated
properly
Epidemiology
• Who has estimated that
- 1/3 of the word’s pop in infected with TB
- the highest prevalence in asia
- 10 % of cases develop CNS disease
• TBM :
- is an serious infectious cause of chronic meningitis in the
developing countries
- death occurs is ± 20-50 % pts with TBM
- the proportion of HIV 1 assiciated TBM can exceed 50 %
Epidemiology
Data TBM from several educational hospitals in Makssar
- 2016 : 47 cases
- 2017 : 60 cases
- january - october 2018 : 36 cases
PATHOGENESIS OF TBM
• Remains incompletely understood
• Occasionally occurs as
- a complication of bacteremia
- an extension directly in to the subaracnhoid space (Pott’s
disease)
- a rupture of tuberculoma in to the subarachnoid space
PATHOGENESIS OF TBM
• Two types of inflammatory reaction
- a chronic inflammatory = granulomatous response
- acute ‘tuberculin’ reaction throughout the subarachnoid space
and ventricular system → exudate is thick and heavy → tend to
marked at the base of the brain → cranial nerve involvement is a
prominent feature of TBM
PATHOGENESIS OF TBM
Three pathological processes :
- The exudate may obstruct CSF flow → HIDROCEPHALUS
- Granuloma colesce → to form TUBERCULOMAS (74 %) or
ABSCESSES
- an abliterative vasculitis → INFARCTION or STROKE SYNDROME
(most common site in the basal ganglia)
CLINICAL FETURES OF TBM
• TBM can occur as :
- the sole manifestation of tb , or
- concurrent with pulmonary or other extrapulmonary site of infection

• The onset is insidious


- low grade fever, headache, stiff neck
- in the early stages : meningeal signs maybe absent

• The duration of symptoms befero presentation :


range from several days to several months
CLINICAL FETURES OF TBM
• TBM cases may present in advanced clinical stages
- GCS ≤ 10
- Cranial Nerve(s) palsies
- hemiparesis, paraparesis
- seizures
- psychotic behaviour
- urinary retention
- vomiting
- after basal ganglia infarction : tremor, chorea, balismus, myoclonus
- hyponatremia due to hypothalamic dysfunction

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