Complication Of Tuberculous Meningitis Research Articles

MRI to demonstrate diagnostic features and complications of TBM not seen with CT

Computed tomography (CT) findings in children with tuberculous meningitis (TBM) often do not explain the clinical presentation and may even be normal. Magnetic resonance imaging (MRI) has the potential to diagnose TBM with greater sensitivity than CT and also to detect more infarcts. The aim of this study was to determine whether MRI demonstrates features and complications of TBM not present on CT. Retrospective, blinded evaluation and comparison of CT and MRI findings in children with TBM were performed. Of 30 children included, MRI demonstrated eight more with basal enhancement and four more with infarctions. Overall, MRI demonstrated an additional 104 sites of infarction (of a total 172) than CT. Of these, 89 were acute and visualized only on diffusion-weighted image. MRI showed five more patients with unilateral and two more with bilateral basal ganglia infarcts than CT as well as 19 brainstem infarcts. Hydrocephalus was equally detected by MRI and CT. MRI is superior to CT for diagnosing TBM (by detecting basal enhancement in more patients) and prognosis (by detecting many more infarcts in strategic locations). The role of CT is defined for the acute setting in detecting hydrocephalus for surgical management.

Intradural Extramedullary Tuberculoma of the Thoracic Spine: Paradoxical Response to Antituberculous Therapy

Intradural extramedullary tuberculoma of the spinal cord (IETSC) is a rare complication of tuberculosis, which can occur as a paradoxical response to antituberculous therapy. A 46-year-old woman with tuberculosis meningitis developed an acute sensory disturbance and paraplegia eight weeks after the antituberculous treatment was started. MRI revealed a cystic lesion at the Th 2 and 3 vertebrae levels, and continuous dural thickening. Laminectomy was performed; soft granulomas were unexpectedly observed inside the dura matter. After the operation, the patient experienced progressive improvement in motor strength. IETSC should be known as rare but possible complication of tuberculous meningitis.

Tuberculous meningitis presenting as mesencephalic infarction and syringomyelia

Cerebral ischaemia is a serious complication of tuberculous meningitis (TBM) with the anterior circulation most commonly affected. Acute syringomyelia is a very rare complication of TBM. Here, we report an unusual presentation of TBM with a third nerve palsy as a result of posterior circulation stroke as well as a syringomyelia.

Persistent increase of matrix metalloproteinases in cerebrospinal fluid of tuberculous meningitis

Matrix metalloproteinase (MMP)-2 and MMP-9 were analyzed by gelatin zymography and an enzyme-linked immunosorbent assay (ELISA) in a cerebrospinal fluid (CSF) from patients with tuberculous meningitis ( n=24), acute aseptic meningitis ( n=23) and the control ( n=10). The MMP-2 and MMP-9 levels were significantly higher in the samples from the tuberculous meningitis patients than those from either the aseptic meningitis patients or the controls. In tuberculous meningitis, the patients with late neurologic complications had higher MMP-2 and MMP-9 levels than those without. The persistent increase in the MMP-2 and MMP-9 levels was associated with the development of complications following tuberculous meningitis. Inhibiting the MMPs may be an effective strategy for preventing or reducing the complications in tuberculous meningitis.

Tuberculosis meningitis and attention deficit hyperactivity disorder in children.

The purpose of this study was to investigate the prevalence of attention deficit hyperactivity disorder (ADHD) in children who recovered from tuberculous meningitis (TBM) as part of an ongoing TBM research project. During this study, each TBM group subject underwent a thorough clinical-neurological examination, and a test battery which included the child behaviour check list (CBCL) Teacher's Report Form and Conners Rating Scale. The parents and teachers of each of the 21 TBM group and 21 control group subjects completed the above-mentioned questionnaires. All 21 TBM group subjects displayed symptoms of ADHD. The TBM group was significantly more hyperactive and unable to sustain attention than the control group. Furthermore, TBM group subjects were perceived as being significantly more unpopular, obsessive, compulsive and aggressive than the control group subjects. With regard to the frequency of externalizing behaviour, the TBM group subjects displayed significantly more externalizing behaviours as well as symptoms of attention deficit and hyperactivity. No significant differences between parents' and teachers' ratings were found. We conclude that ADHD is a common long-term complication of TBM.

A Case of Tuberculous Meningoencephalitis Presenting as Prominent Psychotic Features

Intracranial vasculitis is a rare and disastrous complication of tuberculous meningitis if not treated properly. Focal neurologic deficits according to the vessels involved are common manifestation. Here, we report a 29-year-old man who suffered abrupt, bizarre behavioral changes caused by vasculitis complicating tuberculous meningoencephalitis. The diagnosis of tuberculous meningitis is based upon both the CSF findings and a chest X-ray. His systemic symptoms disappeared by after being administered antituberculous medication but various psychotic features such as hypersomnia, hyperphagia and aggressive behavior continued. A brain MRI showed multiple small parenchymal tuberculous nodules, and the brain MR angiography revealed a narrowing of the proximal middle cerebral arteries and a reduced visualization of the cerebral vessels, suggesting widespread vasculitis. Intravenous dexamethasone successfully ameliorated his behavioral changes. In addition both the follow up brain MRI and angiography showed a normalization of the previous findings.

Syringomyelia as a Complication of Tuberculous Meningitis

Tuberculous meningitis may rarely be followed by the development of syringomyelia despite appropriate chemotherapy. In the present paper, we report a case of tuberculous meningitis in a 23-year-old Vietnamese male complicated by a rapidly progressive myelopathy due to granulomatous arachnoiditis which culminated in the development of a syrinx. The relevant literature is reviewed. The present case supports the hypothesis that vasculitic thrombosis of spinal cord vessels leading to ischemic myelomalacia is the mechanism causing postinflammatory syringomyelia.

Hyaluronidase as an adjuvant in the management of tuberculous spinal arachnoiditis

Spinal arachnoiditis, a complication of tuberculous meningitis, is not uncommon; it may develop despite specific chemotherapy and steroids, and existing avenues of treatment for it are unsatisfactory. The enzyme hyaluronidase, by virtue of its action of hydrolysing the glucosaminidic bonds of hyaluronic acid and other mucopolysaccharides of the ground substance, offers a promising mode of treatment. Sixty-six patients with spinal arachnoiditis secondary to tuberculous meningitis were seen over an 8-year period. All these patients received antituberculous drugs and steroids; 39 of them (group A), who, in addition, were given intrathecal hyaluronidase, fared better than the remaining 27 (group B), who did not receive this enzyme. This study was non-randomised. The disability and functional deficit score showed a significant decrease from 7.6 to 3.7 in the enzyme-treated group in contrast to a mild change from 8.1 to 6.9 in the untreated group. Further, in group A the mortality was 5.2% whereas in group B it was 25.9%. There was a marked 5-fold decrease in mean CSF protein in group A while in group B there was no significant change. There were no serious side effects due to repeated administration of intrathecal hyaluronidase. Thus this study provides convincing evidence of the therapeutic role of hyaluronidase in the management of tuberculous spinal arachnoiditis and replicates our earlier observation of the safety of hyaluronidase given intrathecally.

The Operculum Syndrome: an Unusual Complication of Tuberculous Meningitis

The operculum syndrome, not previously documented as a complication of tuberculous meningitis, is described in a three-year-old African boy. The appearance on CT scan correlates radiographically with anatomical descriptions of the operculum syndrome, and is useful in distinguishing the condition from pseudobulbar palsy.

The use of dexamethasone in preventing ocular complications in tuberculous meningitis

Twenty-seven patients with tuberculous meningitis (TBM) were treated with ethambutol, isonicotinic acid hydrazide, streptomycin and dexamethasone and 28 were treated with triple anti-tuberculous drugs only. Only two of the patients to whom steroids were given developed ocular complications as compared to seven of those not receiving dexamethasone. High dose dexamethasone apparently prevents optic atrophy in TBM. Controlled double-blind studies with and without dexamethasone are needed to confirm this postulation.

結核菌とポリオウイルス2型の混合感染

A 5-year-old female who fell ill with fever on 21st, Nov., 1980 showed vomiting and headache and then was diagnosed as aseptic meningitis. On 2nd Dec. she was admitted to this hospital. Thereafter she had intermittent fever and showed a positive Kernig's sign, stiffness of the neck, stupor, light paresis in left extremities and pain in the abdomen and other parts of body.Cerebrospinal fluid (C.S.F) showed pleocytosis and increment of protein contents. Bacteriological cultures of 3 C.S.F. were found positive for Mycobacterium tuberculosis and the complement fixing serum antibodies against poliovirus type 2 also appeared at the stage between the 27 and 48 days of disease and she showed the rise of the neutralizing antibody titer of serum against this virus strain in the course of the disease. Therefore, she was diagnosed as a complication of tuberculous meningitis and poliomyelitis due to poliovirus type 2.The origin of Mycobacterium tuberculosis was suspected her aunt who had had pulmonary tuberculosis. The origin of poliovirus type 2, however, could not be clarified because she had not received the live vaccine of poliovirus and nobody was suffered from poliomyelitis in her neighborhood. It was tried without effects to isolate the virus from her materials. Then, biological characters of the poliovirus type 2 with which she was infected could not be studied.

CHICAGO NEUROLOGICAL SOCIETY

The history and findings in a case 36 months after onset of tuberculous meningitis were presented. The patient showed residuals and complications of tuberculous meningitis which were unusual in their number and severity. They consisted of impaired vision with optic atrophy, bilateral deafness, extensive weakness of the upper extremities and total paralysis of the muscles of the abdomen and lower extremities. Calculi had been removed from the bladder and left renal pelvis. Extensive decubiti had nearly healed. Despite the above, he had remarkable sparing of his mental faculties. It is of particular interest that he continued to show varying degrees of improvement in the majority of his complications and residuals.