Tuberculous meningitis presenting with nonconvulsive status epilepticus (original) (raw)
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Rare Clinical Presentation of Tuberculous Meningitis: A Case Report
The Malaysian journal of medical sciences : MJMS, 2017
Tuberculosis is the second leading cause of death under the category of infectious diseases, after the human immunodeficiency virus (HIV). Tuberculous meningitis (TBM) constitutes about 5% of all extrapulmonary disease worldwide. This report describes a case of Tuberculous meningitis with rare presentation in a 28-year-old woman, who was treated based on a collection of her social background, clinical findings and Multiplex PCR of tuberculosis. A 28-year-old Malay woman with no significant medical history presented to HUSM with one month history of on and off fever, two weeks history of generalised limbs weakness and one week history of dysphagia. She was reported to have experienced visual hallucination and significant weight loss. Her laboratory result is significant for leukocytosis, elevated ESR and hypernatremia. Non-enhanced and contrast CT scan of the brain showed severe bilateral frontal cerebral atrophy. Cerebral spinal fluid (CSF) for multiplex PCR for complex was positive...
Journal of Emergency Medicine and Intensive Care, 2015
Tuberculosis is a chronic necrotizing granulomatous disease caused by Mycobacterium tuberculosis, causes morbidity and mortality worldwide, and affects children as in all age groups. Tuberculous meningitis (TM) is the most severe form of the disease. The pathogenesis of TM is poorly understood and the best management has not been established. We report 17-years old female patient, who was referred from Somalia with a suspected intracranial mass lesion accompanied by poor general condition, reduced consciousness, hypertension and bradycardia, diagnosed as TM after brain biopsy with result of positive PCR and culture for M. tuberculosis. But the patient died after diagnosis of tuberculous meningitis in the last phase. The aim of this case report is to remind that TM must be considered in the differential diagnosis of intracranial infection in patients from endemic areas and the treatment should be initiated rapidly to prevent delayed diagnosis and lethal complications.
A Case Report on Complicated Tuberculous Meningitis
Cureus, 2017
Tuberculous meningitis (TBM) is associated with significant complications of central nervous system. It is accompanied by nonspecific and heterogeneous clinical symptoms. We focused on the significance of early diagnosis and prompt treatment. We describe a case of TBM in a 19-year-old Asian female. She had a progressive motor weakness with no sensory findings. She was started on antituberculous therapy. Her magnetic resonance imaging (MRI) contrast of dorsolumbar spine showed syringomyelia. Her culture and sensitivity for Mycobacterium tuberculosis (MTB) came negative. She was given a therapeutic trial of quinolones and Steroids. She had an uneventful recovery and was followed up for the past one year.
Tuberculous Meningitis: Literature Review
São Paulo Medical Journal, 2021
Background: Tuberculous meningitis is the most severe form of M.tuberculosis infection, and occurs when there is an invasion of the membranes and cerebrospinal fluid by the bacteria. It develops as a complication of primary infection and reactivation in immunosuppressed. Objectives: This study aims to characterize tuberculous meningitis and bring updates. Design and setting: This is a literature review from the Escola de Medicina Souza Marques‘s students, Brazil. Methods: The used articles were published between 2012 and 2021, from the UpToDate, Scielo, PubMed, and Google Scholar databases. Results: Relevant epidemiological factors, such as HIV, and the absence of the Tuberculosis vaccine could raise the diagnosis hypothesis for the disease. Furthermore, clinical features as headaches, myalgia, fever, emesis, and sudden mood swings are also red flags. Patients should always be tested for HIV infection since mortality in these cases is about 60%. Tuberculous meningitis has a high let...
A Case Report on Tuberculous Meningitis
Journal of Pharmaceutical Research International
Introduction: The most common cause of tuberculous meningitis is a hematogenous spread of mycobacteria from the lungs. tuberculous meningitis is a fatal disease. Symptoms typically worsen over time, and there are three clinical stages to the disease (prodromal phase, phase of neurological symptoms and phase of paresis) Case Presentation: The chief complaint of a one-year-old boy was fever, irritability, vomiting, and Generalized Tonic-Clonic Seizure convulsions. The patient's pupils were found to be unequal on physical examination, prompting a repeat neuroimaging. It was done on MRI (magnetic resonance imaging) with T1 hyperintensity on T2 and restricted diffusion on DWI (diffusion-weighted imaging) he has not improved after taking treatment and the patient is on a ventilator as well, we nasogastric tube also. I was receiving treatment and will continue to do so until the end of my care. Conclusion: In our environment, tuberculous meningitis that presents late is not uncommon. ...
Clinical, Laboratory, and Radiological Evaluation of 32 Cases with Tuberculous Meningitis
Flora the Journal of Infectious Diseases and Clinical Microbiology
Introduction: Tuberculous meningitis is an important central nervous system infection, and it is the most severe clinical form of tuberculosis. Mycobacterium tuberculosis is the frequently isolated microorganism, and it is associated with high morbidity and mortality among central nervous system infections. Despite all the advances in medicine, diagnosis of tuberculous meningitis is still a significant problem. In our study, we aimed to evaluate clinical, microbiological and radiological features of the patients with tuberculous meningitis in detail. Materials and Methods: The study was designed as a retrospective study. A total of 32 patients diagnosed on the basis of clinical, microbiological and radiological criteria with tuberculous meningitis were included into the study. Patients were exposed to computed tomography scan and magnetic resonance imaging with the exception of two patients. Computed tomography scans were performed at the time of admission to the emergency department while magnetic resonance imagings were performed within the 48 hours after computed tomography scans. The data were analyzed with SPSS 24. Results: Eleven of the patients were diagnosed with gold standard methods. The pathogen microorganism was M. tuberculosis in all cases. The diagnoses of other patients were determined by clinical; microbiologic and radiologic estimations. Demographic findings-symptoms of the patients, laboratory findings-symptoms and the contribution of radiology to the diagnosis were evaluated. Particularly, when the contribution of radiology to the diagnosis was studied, it was found that especially magnetic resonance imaging was more useful than computed tomography. Conclusion: Central nervous system infections due to M. tuberculosis are frequently related to high morbidity and mortality. The gold diagnosis methods of the disease are; isolation of M. tuberculosis from the cerebrospinal fluid or seeing the microorganism in the fluid with EZN stain. Because of the low positivity rates in gold standard methods, radiologic methods such as magnetic resonance imaging can be used in tuberculous meningitis diagnosis.
Tuberculous meningitis: many questions, too few answers
The Lancet Neurology, 2005
Tuberculous meningitis (TM) is difficult to diagnose and treat; clinical features are non-specific, conventional bacteriology is widely regarded as insensitive, and assessment of newer diagnostic methods is not complete. Treatment includes four drugs, which were developed more than 30 years ago, and prevents death or disability in less than half of patients. Mycobacterium tuberculosis resistant to these drugs threatens a return to the prechemotherapeutic era in which all patients with TM died. Research findings suggest that adjunctive treatment with corticosteroids improve survival but probably do not prevent severe disability, although how or why is not known. There are many important unanswered questions about the pathophysiology, diagnosis, and treatment of TM. Here we review the available evidence to answer some of these questions, particularly those on the diagnosis and treatment of TM. Panel 1: TM in clinical practice Associated with TM Recent exposure to tuberculosis (especially in children) Evidence of tuberculosis elsewhere (especially miliary tuberculosis on chest radiograph) HIV infection Diagnosis Acute Meticulous microscopy (and then culture) of у5 ml of CSF After treatment commencement PCR of CSF Treatment First 2 months Four drugs: isoniazid, rifampicin, pyrazinamide and either streptomycin, or ethambutol Next 7-10 months Isoniazid and rifampicin Patients without HIV Give dexamethasone, regardless of patient's age or disease severity Panel 2: TM symptoms on presentation 4-9