IT’S IMPORTANT TO CONSIDER
THE FOLLOWING:
5. Lumbar puncture with the study of cerebrospinal fluid is a decisive moment in determining the etiology of meningitis.
6. Examination of the fundus: detection of tuberculous tubercles on the retina, congestive optic discs.
7. Bacteriological examination of cerebrospinal fluid: detection of MTB.
8. Antitubercular antibodies are detected using ELISA (in 90 % of BC).
9. The reaction to tuberculin at the onset of the disease is often reduced, and with the progression of TB becomes negative (tuberculous anergy).
10. On CT or MRI of the brain, dilatation of the ventricles (hydrocephalus) is noted.
Peculiarities of the course of tuberculous meningitis in modern epidemiological settings:
1.The more common acute onset of the disease and its less severe course in all age groups, which is manifested by a decrease in the frequency of meningoencephalic and an increase in the frequency of basilar forms.
2.The life expectancy of patients before and after the start of treatment increased with late diagnosis of the disease in cases of its unfavorable outcome.
3.Less common is an undulating and protracted course of the disease.
4.There are no relapses after treatment.
5.Earlier terms of recovery and more favorable outcomes of a disease at treatment.
6.The complications are less pronounced.
Complications:
1.Hemiparesis.
2.Hydrocephalus.
3.Decreased intellect and vision.
4.Paralysis of the limbs.
5.Epilepsy.
6.Development of full Froin syndrome.
7.The formation of calcifications in the substance of the brain.
8.The development of diabetes insipidus.
Pseudomeningitis
(with pneumonia, influenza, dysentery, typhoid, serous meningitis, epidemic cerebrospinal meningitis and other purulent meningitis, poliomyelitis, acute chronic encephalitis, abscess and tuberculoma of the brain) - the nature of the CSL is normal, the meningeal syndrome quickly disappears.
Serous (aseptic) meningitis:
acute onset, fever, headache, early meningeal symptoms. CSL: clear, colorless liquid, increased protein level to 1.0 g/L, fibrin mesh does not fall out, lymphocytic pleocytosis 100-200 cells per 1 ml, the amount of sugar and chlorides is normal. The general condition is less severe, improving rapidly. Recovery after 2-5 weeks.
Epidemic cerebrospinal meningitis
acute onset, fever up to 39.0 - 40.0ºC, in the first days of the disease - a sharp headache, vomiting, meningeal symptoms. The general condition is severe. On the body there is a petenchial-herpetic rash. CSL: turbid liquid, increased protein level to 0.4-1.5 g/l, neutrophilic pleocytosis 1000-2000 cells per 1 ml, the amount of sugar and chlorides is reduced. Microscopy reveales meningococcus.
Poliomyelitis (meningeal form)
acute onset, signs of nasopharyngitis or gastrointestinal disturbances, undulating temperature, meningeal symptoms appear two days after the onset of the disease, head sweating, pain when pressing on the nerve trunks. Disappear meningeal symptoms → areflexia, decreased muscle tone and flaccid paralysis of the limbs, stiffness of the spine, muscle atrophy. CSL: increased protein level to 0.45 - 0.6 g/L, moderate lymphocytic pleocytosis 100 cells per 1 ml, the amount of sugar and chlorides is normal or reduced.
Acute epidemic encephalitis
acute onset, fever up to 38.0ºC and above, headache, irritability, weakness → drowsiness, psychosensory disorders, ataxia, meningeal symptoms are mild, focal cerebral symptoms, oculomotor disorders occur early. CSL: normal protein level, moderate lymphocytic pleocytosis or normal cell count, normal or increased sugar and chloride levels.
Encephalopyosis
(brain abscess)
complaints of increasing in intensity headache in the temporal region of the head (history may be purulent otitis media), fever up to 39.0 ºC, vomiting not associated with eating, a pronounced symptom of neck stiffness, Kernig’s symptom is positive, in the blood - significant leukocytosis, accelerated ESR. On the fundus - congestive discs of the optic nerves.
Brain tumor
severe local headaches, vomiting associated with a change in body position, a history of epileptiform seizures, CSL: a pronounced protein-cell dissociation. On the fundus - congestive discs of the optic nerves.