TUBERCULOUS MENINGITIS

Oleh:

UNIVERSITAS ABULYATAMA
RUMAH SAKIT UMUM DAERAH MEURAXA BANDA ACEH
 INTRODUCTION
Infection in the central nervous
system (CNS) can occur in several
places.
Data from one hospital in Surabaya in
2000-2001 showed the number of 31
meningitis sufferers. Age less than one
year 22.6%; aged 1-5 years 3.2%; age
5-15 years 6.4%; age 15-25 years 32%;
age 25-45 years 16.1%; age 45-65
years 16; 1%; age over 65 years 3.2%.
Of the 31 patients, eight people
(25.8%) died.
ANATOMY
 DEFINITION

Tuberculous meningitis is inflammation of lining the brain (meningen) caused by the bacterium
Mycobacterium tuberculosis (MTB).

MTB that attacks the CNS is the most serious and deadly complication if without effective treatment.

Tubercellular meningitis usually results from the formation of metastatic cutaneous lesions within the
cerebral cortex or meningen that develops during spread of primary infection lymphohematogens.
 ETIOLOGY

MTB is a gram-positive pleomorphic rod-shaped bacterium, measuring 0.4-3µm has acid-

resistant properties, can live for weeks in a dry state, and slow to multiply (every 15-20 hours).
PATHOPHYSYOLOGY

Proliferative arachnoiditis

Vasculitis

Hydrocephalus Communication
 CLINICAL MANIFESTASION
1. Stage I (initial stage / non specific stage / prodromal phase)14 3. Stage III (coma / paralytic phase)
a. Prodromal lasts 1-3 weeks. Acceleration occurs, lasting for ± 2-3 weeks. At this stage, brain function
b. Usually the symptoms are not typical. disorders are increasingly apparent. This occurs due to brain stem
c. Arise slowly. infarction due to vascular lesions or strangulation by exudates who
d. No neurological abnormalities. experience organization. Symptoms that can occur include:
e. Common symptoms: - irregular breathing
- Fever (not too high). - high fever
- Feeling weak. - papillary edema
- Decreased appetite (anorexia). - hyperglycemia
- Abdominal pain. - awareness decreases
- Headaches. - irritable and apathetic
- Sleep disturbed. - sleepy
- Nausea. - stupor
- Vomiting. - comma
- Constipation. - the extensor muscles become stiff and spasm
- Apathy. - opistotonus
- pupils dilate and do not react at all
- pulse and breathing become irregular
2. Stage II (transitional stage / meningitic phase) - hyperpyrexia

In this phase stimulation occurs in the lining of the brain /

meningen. Characterized by neurological abnormalities, due to
exudates formed above the cerebral arch. Stiff neck examination
(+), Kernig and Brudzinski reflexes (+) except in infants.
 DIAGNOSTIK

PUNGSI CHEST X-
LUMBAR RAY

HEAD
CT / MRI
 TREATMENT

Stop seizures: with Diazepam 0.2-0.5 mg / KgBB / IV dose or 0.4-0.6 mg / KgBB / rectal
suppositoria dose. Phenytoin 5 mg / KgBB / day IV / PO divided into 3 doses or Phenobarbital
5-7 mg / Kg / day IM / PO divided into 3 doses.

Reducing fever: Antipyretics: Paracetamol 10 mg / KgBB / PO dose or Ibuprofen 5-10 mg /

KgBB / PO dose given 3-4 times a day, Compress warm water / usual and Supportive
treatment: Intravenous fluids and Oxygen. Try to keep O2 concentrations in the range of 30-
50%.

ATD: 2RHZE/7RH + STEROIDS

 COMPLICATION

The most prominent complication of tuberculosis

meningitis is neurological sequelae (sequel).

The patient's prognosis is directly proportional to the

clinical stage at which the patient is diagnosed and
treated.
THANK YOU