Complication Of Tuberculous Meningitis Research Articles

Single-cell analysis reveals changes in BCG vaccine-injected mice modeling tuberculous meningitis brain infection

Tuberculous meningitis (TBM) is the most severe and deadly manifestation of tuberculosis. Neurological complications are observed in up to 50% of patients affected. Here, attenuated Mycobacterium bovis are injected into the cerebellum of mice, and histopathological images and cultured colonies confirm successful brain infection. Then, whole-brain tissue is dissected for 10X Genomics single-cell sequencing, and we acquire 15 cell types. Transcriptional changes of inflammation processes are found in multiple cell types. Specifically, Stat1 and IRF1 are shown to mediate inflammation in macrophages and microglia. For neurons, decreased oxidative phosphorylation activity in neurons is observed, which corresponds to TBM clinical symptoms of neurodegeneration. Finally, ependymal cells present prominent transcriptional changes, and decreased FERM domain containing 4A (Frmd4a) may contribute to TBM clinical symptoms of hydrocephalus and neurodegeneration. This study shows a single-cell transcriptome of M.bovis infection in mice and improves the understanding of brain infection and neurological complications in TBM.

Incidence and Risk Factors of Cranial Nerve Palsy in Patients with Tuberculous Meningitis: A Retrospective Evaluation.

Tuberculous meningitis (TBM) is a common form of central nervous system (CNS) tuberculosis (TB). Cranial nerve palsy is a serious complication of TBM. Literature regarding this subject is still limited in China. This study evaluated the incidence of cranial nerve palsy in patients with TBM in South China, its association with the clinical forms of TB, and other patient characteristics. A retrospective chart review of patients with a diagnosis of TBM between January 2004 and December 2019 was conducted, and the demographic characteristics, clinical characteristics, and laboratory results of 114 patients were collected and followed up for 3 months. A multivariate logistic regression analysis model was used to explore the risk factors of cranial nerve palsy in patients with TBM. A total of 114 patients were enrolled in this study. Cranial nerve palsy was observed in approximately 38 (33.3%) of TBM patients. Among them, 13 (28.3%) had optic nerve palsy, 24 (52.2%) had oculomotor nerve palsy, 5 (10.9%) had abducens nerve palsy, 2 (4.3%) had auditory nerve palsy, 1 (2.2%) had glossopharyngeal nerve palsy, and 1 (2.2%) had vagus nerve palsy. Using logistic regression analysis, focal neurological deficit, extracranial TB and cerebrospinal fluid (CSF) total white cell count (WCC) were shown to be risk factors for cranial nerve palsy. The prevalence rate of cranial nerve palsy was 33.3% in patients with TBM. Focal neurological deficits, extracranial TB and CSF total WCC are important predictors of cranial nerve palsy in patients with TBM.

Non-communicating hydrocephalus a complication of tuberculous meningitis

This paper explores the topic of non-communicating hydrocephalus as a complication of Tuberculous meningitis (TBM). It covers various aspects related to TBM and its associated complications, including clinical presentation, diagnostic procedures, management strategies, and patient care. The importance of early diagnosis, initiation of antituberculous therapy, and surgical interventions such as endoscopic septum pellucidotomy and external ventricular drain placement are discussed in relation to managing hydrocephalus in TBM patients. The significance of close monitoring, supportive care, adherence to medication, and infection control measures is emphasized. Additionally, the paper highlights the need for patient education, family support, and addressing financial concerns in the holistic care of individuals with TBM. Overall, this paper provides valuable insights into the understanding and management of non-communicating hydrocephalus as a complication of Tuberculous meningitis.

Pioneer shunt implantation surgery in Brazil

One of the first experiences of shunt implantation in the world occurred in 1949, by Nulsen and Spitz, who implanted a rubber catheter with a ball valve system, from the lateral ventricle to the internal jugular vein [1]. In the 1950s, the shunt systems had great development, especially the Spitz-Holter system, first used in 1956, consisting of the first system produced on a large scale. The second patient who benefited from this new system was Holter's son Casey, who had myelomeningocele [2,3]. From these first American reports, the shunt surgery had great worldwide dissemination in the 1960s. One of the first CSF shunts in Brazil and Latin America occurred in 1966, in the city of Uberaba, Minas Gerais, by Prof. Francisco Mauro Guerra Terra, founder of the Chair of Neurosurgery at Triângulo Mineiro Medical School, today part of Federal University of Triângulo Mineiro (UFTM). The procedure was performed at the Children's Hospital of Uberaba, at the time one of University Hospitals, and the patient was a 7-month-old baby named Maria Beatriz. The child suffered from hydrocephalus, as a complication of tuberculous meningitis, and was diagnosed by pneumoventriculography, a procedure described by Dandy, and widely used in the era before tomography [4] (Fig. 1). The child was submitted to a ventriculo-atrial shunt (Figs. 2, 3 and 4), with implantation of a catheter without a valve, an option widely used at the time. Besides Prof. Guerra, the surgical team was composed by the then medical students Jaime Olavo Marquez, later titular of the Neurology Department of UFTM, Antônio Luiz da Costa Sobrinho, later a neurosurgeon, who later settled in Presidente Prudente, São Paulo, Brazil Carlos Antunes de Paula, also later a neurosurgeon, who settled in the city of Santos, São Paulo, Brazil and the anesthesiologist Dr. Newton Camargo Araújo, from Uberaba (Fig. 5). There is a postoperative image of the case, showing the success of the procedure (Fig. 6). The surgery had great repercussion in the national media at the time (Fig. 7).

Особенности течения милиарного туберкулеза у подростков

Особенностью течения туберкулеза в подростковом возрасте является склонность к прогрессированию, некротическим реакциям. Наиболее тяжелым исходом милиарного специфического процесса является развитие менингита, что нередко может быть его терминальной стадией. Цель работы — изу­чить особенности течения милиарного туберкулеза в сочетании с менингитом туберкулезной этиологии у подростка на примере клинического случая. Особенностями течения милиарного туберкулеза в сочетании с менингитом туберкулезной этиологии у подростка были: развитие побочных реакций на длительный прием комплексного противотуберкулезного лечения и гормонотерапии (токсический гепатит, болезнь Иценко — Кушинга вторичного генеза); осложнение туберкулезного менингита ишемическим инсультом в подкорковых отделах левой гемисферы большого мозга и нисходящей атрофией зрительных нервов положительная динамика при правильно подобранном режиме противотуберкулезной химиотерапии как проявлений милиарного туберкулеза, так и специфического менингита.

Early Hydromyelia as a Rare Complication of Tuberculous Meningitis.

Syringomyelia is an uncommon late complication of tuberculous meningitis with a latency period of up to 18 years. Acute hydromyelia is exceedingly rare with few case reports occuring within the first 6 weeks.We present a case and magnetic resonance imaging of a 38-year-old immunocompetent woman with this rare complication of early hydromyelia due to tuberculous meningitis which responded to ventriculoperitoneal shunting, highlighting that early detection and treatment may improve prognosis.

Complications of tuberculous meningitis and their effect on outcome in a tertiary care cohort.

BACKGROUND: To report the frequency and severity of complications, and their effect on the outcome of tuberculous meningitis (TBM).METHODS: In this retrospective cohort study, the following TBM complications were observed: status epilepticus (SE), hydrocephalus, paradoxical clinical worsening (PCW), hyponatremia, drug-induced hepatitis (DIH), infarction and mechanical ventilation (MV). These were recorded and correlated with stage of meningitis and outcome.RESULTS: A total of 144 patients with TBM (median age 26 years, range 12-75) were included. There were 76 (52.8%) females. The patients were in Stage I (n = 33), Stage II (n = 82) and Stage III (n = 29); 58 had definite TBM. Complications occurred in 128 (88.9%); complications included hydrocephalus (n = 58, 40.3%), hyponatremia (n = 70, 48.6%), infarction (n = 48, 33.3%), DIH (n = 42, 29.2%), SE (n = 16, 18.0%), MV (n = 43, 29.9%) and PCW (n = 24, 16.7%), with variable overlap. By 6 months, 33 patients had died. Death was related to PCW (P = 0.016), hyponatremia (P = 0.03), MV (P = 0.02), infarction (P = 0.03) and the number of complications. Except PCW, most complications occurred during the first month.CONCLUSIONS: In TBM, complications occurred in 128 (88.9%) patients, mainly in the early stages, with variable overlap. Infarction, PCW, hyponatremia and MV were predictive of poor outcome.

Complications of tuberculous meningitis in magnetic resonance imaging in a patient with systemic lupus erythematosus

Complications of tuberculous meningitis in magnetic resonance imaging in a patient with systemic lupus erythematosus

Cerebrovascular complications in tuberculous meningitis-A magnetic resonance imaging study in 90 patients from a tertiary care hospital.

Cerebrovascular complications of tuberculous meningitis (TBM) are associated with increased morbidity and mortality. We retrospectively reviewed clinicoradiological findings of 90 TBM patients who presented to a tertiary care hospital, with emphasis on frequency and distribution of infarcts on diffusion imaging and pattern of vascular involvement on magnetic resonance (MR) angiography (MRA). MR images of 90 TBM patients at presentation (2012-2018) were coanalyzed by two radiologists for tuberculomas, leptomeningeal enhancement (LM), hydrocephalus, infarct and vascular abnormalities. Infarcts were categorized based on location ("tubercular" (TB) or "ischemic" zones) and arterial supply (perforators and cortical branches). Clinical and laboratory findings were correlated with imaging data. Ninety TBM patients (age 10-82 years) were enlisted after application of inclusion criteria. Tuberculomas were most common (100%) followed by LM (84.4%), cerebral infarcts (57.7%) and hydrocephalus (29%). Location-wise, 35% infarcts were in ischemic, 13% in TB and 15% in both zones. According to arterial supply, infarcts equally (50%) involved perforators from the lateral lenticulostriate and posterior cerebral (PCA)/basilar artery (BA) followed by medial lenticulostriate arteries (23%). MRA was available in 74.4% and abnormal in 43.2%. The middle cerebral artery was frequently involved (76%) followed by the anterior cerebral artery (38%), internal carotid artery (31%), PCA and BA. Six had diffuse narrowing with a paucity of distal vessels. Cerebral infarction was associated with hydrocephalus (p = .0019) and vasculitis (p < .001). In TBM, strokes are common and mainly involve the perforators and cortical branches. MR is the imaging modality of choice for early diagnosis and timely management.

Secondary complications in tuberculous meningitis in children: A prospective cohort study from India

Background : There is a paucity of data on nature and frequency of complications during the course of management of Tuberculous Meningitis (TBM) in developing countries. Methods : This was a single center prospectivecohort of children less than 12 years of age diagnosed with TBM from January 2011 to Aug 2015. Results : Out of 281 children with TBM, hydrocephalous was present 245 children out of which 206 children needed neurosurgical intervention.24.3%, 35.5 % and 40.2% were in stage 1, stage 2 and 3(MRC) respectively. 164children underwent ventriculo-peritoneal shunt, 32 external ventricular drainage, and 10 underwent Omayya chamber drainage. Major complications were Shunt infection/Ventriculitis-16(7.7%) and Shunt Block 11(5.3%), Shunt Tract hemmorhage 12(5.8%). Other complications that were noted includedpersisting hydrocephalous after shunt, post shunt hygroma, shunt fracture, CSF ascites/ pseudocyst, skin Problems at shunt site, and intraventricular hemorrhage. 59.6%(n=148) had serum sodium <135meq/L and 37% (n=92) had a serum sodium <130 meq/L. Furthermore, 3.6%(n=9) had cerebral salt wasting, 5.2%(n=13) had SIADH and 1.25%(n=3) had central diabetes insipidus. While more than one of these entities was seen in 3 children. Suspected hospital acquired sepsis needing adding of second line antibiotics was seen in 24.26% of the children. Conclusion : In this cohort of children in resource constraint setting who present with advanced hydrocephalous and severe encephalopathy, the major shunt complication rates like infection and malfunction were remarkably low compared to available literature.

Frequency of Hydrocephalus in Cases of TBM

Tuberculosis meningitis (TBM) is a serious public health problem in developing countries as it leads to significant mortality and residual neurological squeal. The estimated mortality due to TBM in Asia is 1.5 per 100,000 populations. Objectives: To determine the frequency of hydrocephalus in cases of TBM. Methodology: This was a cross sectional study conducted during July 2016 to December 2016 conducted at Department of Medicine Services Hospital, Lahore. The detailed demographic data was collected. Cases fulfilling the criteria of TBM underwent CT scan of brain (with IV contrast) for confirmation of TBM at the Department of Radiology, Sheikh Zayed hospital Rahim Yar Khan. Results: In this study there were 93 cases, out of which 54 were males and 39 females with mean of 34.13±9.45 years. Hydrocephalus was seen in 61 (65.59%) out of 93 cases of TBM. It was seen significantly higher in male group where it caused it in 40 out of 54 males (74.1%) with p value of 0.04 (table 1). In context of age groups with respect to hydrocephalus it was seen maximum in patients with age group of 31 to 40 years affecting 12 (80%) out of 15 of its respective group. It was followed by 41 to 50 years affecting 28 (68.3%) of 41 cases, though this difference was not found statistically significant with p value of 0.24. Hydrocephalus was observed maximum in stage I of TBM where it affected 4 out of 5 cases followed by stage II with 36 of 52 cases and then stage III with 21 of 36 patients. This difference was also not significant with p= 0.44. Conclusion: Hydrocephalus is an important and deadly complication of tuberculous meningitis and is noted in every 2 (65.59%) out of 3 cases. There is significant association of male gender with hydrocephalus.

Unusual presentation of tuberculous meningitis: Two case reports

Introduction Central nervous system tuberculosis is a serious health problem worldwide and accounts for more than 7% of all cases of tuberculosis especially in developing countries with high prevalence of tuberculosis and also should be considered in high risk patients or in patient emigrated from regions with a high prevalence of tuberculosis. Tuberculous radiculomylitis is a complication of tuberculous meningitis which has been infrequently reported in medical literature. Case description Case I: A 49-year-old previously healthy Filipino female with 5 days history of fever, back pain radiating to both legs followed by acute onset of lower limb weakness and urine retention one day prior to presentation. Physical examination revealed pyrexia, alert patient, no sign of meningeal irritation and lower limb power decrease (3/5) normal exam of upper limb. Investigation showed elevated WBC in Cerebral Spinal Fluid (60% lymphocyte). Positive PPD and positive quantiferon test. MRI showed extensive enhancement around nerve roots extending cranially to lower thoracic. Patient started on antituberculous treatment, steroid and physiotherapy. Six month post treatment did not show significant neurological improvement, but fever respond after start of treatment. Case II: A 27-year-old healthy Filipino female, presented with history of fever, headache, neck and back pain with vomiting, three weeks prior to presentation and was treated as case of otitis media with two different antibiotic given during two primary health care visits. Presented with one day lower abdominal pain with urinary retention and body weakness. Physical exam showed lethargic patient afebrile with spastic quadriparesis power of upper limb 4/5 and lower limb 3/5. Investigation showed cerebrospinal fluid, high WBC (90% lymphocyte), high CSF protein and low glucose. High serum ESR. MRI showed increase leptomeningeal enhancement of spinal cord extending to the pons. Patient also started on steroid and antituberclous drugs. Patient made good clinical recovery and discharged. Results and conclusions In patient with tuberculous meningitis, an early diagnosis and initiation of therapy plays a major role in preventing unnecessary morbidity and mortality. In several series, use of the steroid has been considered beneficial and should be given for secondary neurological complications, associated with tuberculous meningitis. Emergency clinician must be aware of unusual presentation of tuberculous meningitis and other different causes of lower limb weakness. Neuroimaging with MRI with and without contrast and lumber puncture is critical for diagnosis.

Central Neurological Complications in Tuberculous Meningitis in human Immunodeficiency Virus-Negative Adults

Central Neurological Complications in Tuberculous Meningitis in human Immunodeficiency Virus-Negative Adults

A rare complication of tuberculosis: Acute paraplegia

Tuberculous radiculomyelitis(TBRM) is one of the complications of neurological tuberculosis and includes cases of arachnoiditis, intradural spinal tuberculoma or granuloma, and spinal cord complications of tuberculous meningitis (TBM). Here, we report a case of TBRM which presented with acute paraplegia. Neurological examination on admission revealed flaccid paralysis, bilateral extensor plantar responses, and exaggerated deep tendon reflexes. Cerebrospinal fluid analysis showed xanthochromic fluid that contained 600 cells/mm3, 98% lymphocytes, protein 318 mg/dl and glucose 51 mg/dl (blood glucose 118 mg/dl). On thorax CT, calcified lymph nodes that were sequelae of primary tuberculosis infection was detected. Antituberculosis and intravenous corticosteroids treatment was started. Seven weeks from the onset, on-control spinal MRI myelomalacia was determined, and there was no leptomeningeal enhancement. After six weeks of rehabilitation, lower limb total motor score was increased from 0/50 to 15/50. Tuberculous radiculomyelitis is a complication of TBM. It is rarely seen.

Vascular complications of tuberculous meningitis: An autopsy study

Vascular complications have the most serious consequences in patients with tuberculous meningitis (TBM). Although stroke is seen in approximately 20% of patients with TBM, the underlying vascular damage and infarction are much more extensive. This study has been undertaken to study the pathology at different levels of cerebral vessels and their resultant complications in TBM. Fifty-one postmortem TBM brains were examined over a period of 16 years (1997-2012). The vascular pathology was studied in detail. Changes in middle cerebral artery (MCA) and basilar artery (BA) and their branches at different levels were analyzed in all cases. The age of the patients ranged from 3 months to 72 years. Infarcts were found in 37 cases, among which they were grossly visible in 27 cases. Macroscopic infarcts were more common in MCA territory whereas microscopic infarction was more in BA distribution-brainstem and cerebellum. Vascular involvement was almost universal, with smaller branches of both MCA (94%) and BA (100%) carrying the brunt of the disease, whereas the larger branches were variably involved. Infiltrative lesions were most common at all levels; necrotizing lesions were more common in smaller branches, whereas proliferative changes were seen more in larger branches. This study showed extensive damage of cerebral vessels in TBM, which was responsible for the presence of widespread infarctions. Microscopic infarctions in the brainstem and cerebellum were much more common than reported by radiological studies. Thus, more aggressive management of TBM is required to combat its vascular complications.

Tuberculous syringomyelia in an HIV-infected patient: a case report

A 37-year-old HIV-positive Gambian woman presented with spastic weakness of the right leg six years after receiving treatment for tuberculous meningitis (TBM). Magnetic resonance imaging (MRI) of the spine showed a multiloculated syrinx in the thoracic spinal cord extending from the T2 to the T11 level. Syringomyelia and syringobulbia have been reported as complications of TBM. We describe the first case of syringomyelia as an uncommon late complication of treated TBM in the setting of HIV infection. Early recognition of this rare entity may avoid irreversible neurological sequelae.

Tuberculous cerebral vasculitis: Retrospective study of 10 cases

Background Tuberculous cerebral vasculitis is a complication of tuberculous meningitis. This study was undertaken to determine the epidemiological characteristics, context, diagnostic means and outcomes under treatment of tuberculous cerebral vasculitides. Methods All consecutive patients diagnosed with tuberculous cerebral vasculitis were identified from the databases of three Internal Medicine, one Neurology and one Infectious Disease Departments in three suburban Parisian hospitals. Results We describe 10 cases: five men and five women (median age 33.5 [range: 27–55] years). Two were infected with the human immunodeficiency virus. Nine patients had tuberculous meningitis, eight with extraneurological involvement. The following manifestations led to the diagnosis: motor deficit, acute confusional state, headaches, involvement, coma and/or seizures. The cerebral vasculitis revealed tuberculosis in three patients, but tuberculosis was already known when vasculitis was diagnosed for the seven others. The cerebral computed-tomography scan showed cerebral infarctions in five patients, hydrocephalus and tuberculomas in four, while magnetic resonance imaging detected infarctions and leptomeningitis in nine patients, pachymeningitis in one, hydrocephalus and tuberculomas in seven. Therapy combined antituberculous agents with oral corticosteroids for all patients, preceded by a methylprednisolone pulse for five patients. Outcome was favorable for nine patients. Conclusion We described the non-negligible frequency of tuberculous cerebral vasculitides, their clinical manifestations and their potential severity, and the diagnostic and monitoring contributions of magnetic resonance imaging and magnetic resonance angiography.

Tuberculous optochiasmatic arachnoiditis

Arachnoiditis involving optic nerve and the optic chiasm can occur as a complication of tuberculous meningitis (TBM). This study evaluates the clinical features, cerebrospinal fluid (CSF) and laboratory parameters and imaging findings of optochiasmatic arachnoiditis (OCA) and also tried to identify any factors which can predict this complication in patients with TBM. Patients admitted with TBM in the neurology wards of a tertiary care teaching hospital over a period of 6 years formed the material for this study. Student's "t" test and univariate analysis were done to identify any predictors for this complication and the variables found to be significant were further analyzed by multivariate logistic regression analysis. One hundred sixty-three patients with TBM, admitted over a 6-year period, were studied. Twenty-three (14%) patients developed OCA. Eighteen out of 23 (78%) developed this complication while on antituberculous treatment (ATT) and 5/23 (22%) were newly diagnosed cases of TBM. Of those already on treatment, 12/23 (52%) were receiving only ATT, the remaining 6/23 (26%) had received steroids along with ATT in varying doses and duration. The average period from diagnosis of TBM to visual symptoms was 6.4 months. On the multivariate logistic regression analysis, female sex (P < 0.037), age less than 27 (P < 0.008) years and protein content in the CSF > 260 mg% (P < 0.021) were the factors predisposing toward this complication. At 6 months follow-up, on treatment with steroids and ATT, 17% had improvement and no further deterioration was noted in visual acuity in 52%. OCA can develop even while on treatment with ATT. Young women with a high CSF protein content seem to be more prone for this complication.

Devastating yet treatable complication of tuberculous meningitis: the resistant TB abscess

Tuberculous abscesses may be resistant to medical treatment and may cause devastating complications. Such a lesion persisted in a child treated for tuberculous meningitis and resulted in a seizure with prolonged anoxic damage to the brain. The imaging findings are typical and these lesions should be considered for surgical management.

Hyaluronidase as an adjuvant in the treatment of cranial arachnoiditis (hydrocephalus and optochiasmatic arachnoiditis) complicating tuberculous meningitis.

Use of subarachnoid/intraventricular administration of hyaluronidase in the treatment of 15 cases of cranial arachnoiditis which occurred as a complication of tuberculous meningitis is reported. Eleven of these cases had communicating hydrocephalus and four had optochiasmatic arachnoiditis. An average of 4.5 injections were administered at weekly to fortnightly intervals. These patients had been followed-up for a mean period of 6.1 months per patient. Serious side effects such as flare-up of the underlying meningitis process, miliary spread of tuberculosis, convulsions or allergic reactions were not observed. Improvement of sensorium and/or neurological deficit was observed in 14 of the 15 cases. A clinically comparable group of 15 cases subjected to shunt surgery (14) and ventricular drainage (1) were considered as "control". This medical method of treatment appears to be superior to shunt surgery and offers a simpler alternative line of management of cranial arachnoiditis/hydrocephalus complicating tuberculous meningitis.