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