Tuberculous meningitis and encephalitis

Proven content

Tuberculous meningitis is the most severe form of tuberculosis and the most dangerous to health. It is usually located in the central nervous system, where it grows simultaneously. This type of tuberculosis is caused by the spread of mycobacteria in the blood. The disease progresses rapidly amidst headaches and deteriorating health.

What is tuberculous meningitis?

Tuberculous meningitis is the most severe and life-threatening form of tuberculosis. It is located in the central nervous system and it also develops there. The cause of this ailment is the dispersal of mycobacteria in the blood, which usually attack the lungs, central nervous system or circulatory system. In the beginning, inflammation develops without causing concern, despite the presence of certain low-grade fever, but more often the disease develops rapidly among persistent headaches, vomiting, rapidly deteriorating general condition, light-headedness up to and including profound loss of consciousness. Treatment is implemented immediately after diagnosing the ailments, it lasts no less than 9-12 months.

The causes of tuberculous meningitis

This type of tuberculosis occurs when the contents of the tuberculosis enter the subarachnoid space. This usually happens several weeks to several years after infection. Inflammation occurs, and it affects the brain most strongly, where the exudate accumulates. The inflammation damages the cranial nerves and blocks the circulation of the cerebrospinal fluid. Tuberculous meningitis can also affect blood vessels, which often results in a cerebral infarction.

Development of tuberculous meningitis

The development of this ailment can be divided into three phases.

1. Phase I – the patient develops symptoms such as: low-grade fever, malaise, anorexia, headaches lasting up to several weeks.
2. Phase II – these are neurological symptoms, among which we mention: drowsiness, impaired consciousness, severe meningeal syndrome and paralysis of the cranial nerves.
3. Phase III – characterized by the appearance of paralytic symptoms, which, in addition to coma, are accompanied by increased intracranial pressure and expansion of fluid spaces inside the skull.

Due to the non-specific course of tuberculous inflammation and the slow worsening of symptoms, the diagnosis of this disease is difficult. As a consequence, treatment is delayed and the prognosis worsens. Attention! In children, tuberculous meningitis and encephalitis develops much faster than in adults. Children complain of abdominal pain more often, and the characteristic symptom is post-cerebral stiffness.

Common symptoms of meningitis

Typically, the patient is transported to the hospital when he becomes unconscious. Due to the ambiguity of symptoms, it is difficult to react earlier, as symptoms may indicate a different type of ailment.

The initial symptoms of the disease include:

1. headaches,
2. high temperature,
3. somnolence,
4. vomiting and nausea.

Over time, there are seizures and neck stiffness. Patients begin to see double and feel oversensitive to light. In addition, there are problems with proper speaking and disturbed consciousness. Limb paresis is not uncommon.

Diagnosis of tuberculous meningitis and encephalitis

Diagnostics is possible only in a hospital after clinical observation and after biochemical, cytological and bacteriological examination of the cerebrospinal fluid. Since tuberculous meningitis is usually secondary to pulmonary tuberculosis, chest X-ray and magnetic resonance imaging are performed. Tests reveal changes that are a consequence of tuberculosis. In addition, a tuberculin test is performed.

Sometimes a fundus examination is performed to help determine the location of the tuberculous nodules.

We can suspect tuberculous meningitis in people who develop:

1. pericardial effusion of unknown etiology,
2. pus in urine
3. inflammation of the lymph nodes,
4. pleurisy or peritonitis,
5. osteomyelitis,
6. a high number of lymphocytes in the cerebrospinal fluid, and a high concentration of protein and a low level of glucose.

Tuberculous meningitis and encephalitis – treatment

Treatment of this ailment can be: specific, anti-tuberculosis, long-term, lasting for many months.

The results of treatment depend on the severity of tuberculous lesions and the degree of advancement of a given disease process. Therefore, one should not postpone during a medical visit and specialist examinations, especially when in the family of a tuberculosis patient there are low-grade fever, persistent headaches, nausea, heaviness, drowsiness, apathy, etc.

Early initiation of appropriate treatment promises complete recovery without leaving any traces of the disease. On the other hand, too late treatment may not prevent permanent changes in the brain or meninges.

In order to prevent death in patients with tuberculous meningitis, anti-mycobacterial preparations are administered even in suspicion, because time plays a major role here. Among these drugs, we can distinguish: rifampicin, isoniazid or streptomycin.

What’s the prognosis?

The prognosis for this disease depends on the phase of the disease in which the treatment was initiated. The situation is worse in the elderly and in children. Mortality in unconscious patients is 50-70%. Despite recovery, more than half of the patients suffer from permanent damage to the nervous system. Tuberculous meningitis can cause complications such as:

1. epilepsy
2. hydrocephalus,
3. memory loss,
4. vision loss,
5. hearing loss
6. cranial nerve palsy,
7. intellectual impairment (especially if the inflammation occurred during childhood).

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