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19 September 2018
OUTLINE
Introduction
Classification of Neuro-tuberculosis
Epidemiology
Pathophysiology
Clinical features
COMPLICATIONS
PROGNOSIS
introduction
TB is a contagious air borne disease that typically effects the lungs
particularly the alveoli, its caused by a mycobacterium tuberculosis, a long
slender straight curved acid fast bacilli, slow growing , obligate aerobes
intracellular bacteria which has mycollic acid, overall if the TB infection is
not treated quickly the bacteria can travel through the blood stream to infect
other organs and tissues like meninges, thus the infected meninges results a,
life threatening condition known as TB meningitis
So TB meningitis is one of usual infections that if you do not treat it, its
very fatal, if you delay treatment or we do not give treatment at all, a
100 % die,
A number of people is reduced according to how early you get
the treatment of the disease
1: pots spine
2: Tubercular arachnoiditis
3: Spinal tuberculoma
4: Spinal meningitis and radculomyelitis
Epidemiology
TB is the seventh leading cause of death and disability worldwide. In TBM
is more common in children then adult.
75-85% below age 5 years , uncommon below 6m and rere below 3m .
Peak incidence is 3m-5yrs.
TBM account 1-2% of the cases with TB and 9.1% of extra-pulmonary TB
.
In 1997, TBM was the fifth most common form of extrapulmoinary TB.
In subsahara africa b/c of affect of HIV become high endemic, and 75% of
HIV pts developed TB and 1% of them developed TBM .
Pathophysiology
Droplet infection
Rich Focus
Rupture in
Subarachnoid
space
ADHENSION
Vasculitis Encephalitis
BASAL Stroke
Inter Cerebral
CISTERN
A pedencular Edema
fossa
stage 1 ( early or ) : -
anorexia, vomiting
headache , irritability
sleep disturbance
3: Neurological deficits
b) Motor deficits
5: Impaired consciousness
Stage 3 ( advanced ) :-
3: Movement disorders
A) Mandatory features
a) evidency of extraneural TB
hydrocephalus
infarcts
gyral enhancement
Approach to the pt with TBM
History taking
Physical examination
Investigation
management
History taking
Sings and symptoms of TB
Past history of TB
Poor feeding
Anthropometric measurement
Neck : Stiff neck , unable to hold neck and brunzik sing positive
Heart :murmur
Investigations
CBC
CSF analysis
Chest x-ray
CT-scan
ESR
GASTRIC LAVAGE OR SPUTUM EXAMINATION for
tubercle bacilli.
MANAGEMENT
Specific Treatment:
It causes orange discoloration of the urine and tears , GIT disturbance and
hepato-toxicity.
s
Dosing Chart
GENERAL MEASURES
1. Corticosteroids:
Decrease mortality rate and long term neurologic sequelae.
4. Deafness
5. Hydrocephalus
6. Hemiplegia, paraplegia
7. Epilepsy
9. Tuberculoma.
PROGNOSIS:
It depends upon two factors:
1. Age of patient
Even with optimal therapy mortality ranges from 30-50% and incidence of
neurologic sequelae is 75-80% especially in stage 3.
Infants and young children have poor prognosis as compared to older children