A Study on the Clinical Features and Complications of Tuberculous Meningitis in a Tertiary Care Centre of Southern India

Abstract

The study was carried out to describe the current epidemiology, clinical features, complications and outcomes in patients with tuberculous meningitis (TB Meningitis) in a tertiary care hospital of southern India. SETTING: Sri Chamarajendra District Hospital which is attached to Hassan Institute of Medical Sciences, Hassan, Karnataka, India. STUDY DESIGN: A recordbased retrospective descriptive study. MATERIALS AND METHODS: Seventy cases of confirmed cases of tuberculous meningitis were studied between January 2011 and December 2013.The diagnosis of TB Meningitis was based on clinical and laboratory features. The data on the demographic factors, clinical features, complications, details of treatment and the outcome of these patients were recorded and analyzed. RESULTS: The mean age of the patients was 39.27 +/-7.8 years with slight male predominance 39 (55.7%). Most common presenting features were fever (92.8%), altered sensorium (80%), and neck stiffness (77.2%). Among CNS (Central Nervous System) signs 63(90%) had signs of meningeal irritation, 21(30%) had cranial nerve palsies and 13 (18.57%) presented with Hemiplegia. 48(68.5%) patients presented in MRC (Medical Research Council) stage 2. The study revealed overall mortality of 11.42%, 38(54.28%) patients recovered completely without any residual deficits and 24(34.30%) patients had residual neurological sequelae. CONCLUSIONS: Tubercular meningitis is a serious central nervous system infection associated with significant mortality and high morbidity among survivors. The only way to reduce mortality and morbidity is by early diagnosis, timely recognition of complications and institution of appropriate treatment strategies.

Tracking down the White Plague. Chapter two: The role of endocranial abnormal blood vessel impressions and periosteal appositions in the paleopathological diagnosis of tuberculous meningitis

“…TBM usually develops subsequent to the rupture of one or more meningeal, subpial, and/or subependymal caseating tubercles into the subarachnoid space or into the ventricular system, both occupied by the cerebrospinal fluid (CSF) [54][55][57][58][59][60][61][62][63][64][65][66][67][68][69]. The release of sufficient numbers of TB bacteria into the CSF triggers the onset of diffuse granulomatous inflammation of the leptomeninges, with strong predilection for the basal areas of the brain [54][55]62,[65][66][67][68]70]. Nonetheless, not only the pia and arachnoid mater but additionally, the outermost meningeal layer (i.e., the dura mater) can be affected by the disease [71].…”

“…Nonetheless, not only the pia and arachnoid mater but additionally, the outermost meningeal layer (i.e., the dura mater) can be affected by the disease [71]. Besides the small tubercles primarily formed in the leptomeninges and later also in the dura mater, characteristic pathological features of TBM include enhancing basal meningeal exudate, progressive hydrocephalus, and vasculitis of the blood vessels adjacent to or traversing the exudate [57,[59][60]62,64,67,[69][70][71]. In TBM, not only the intracranial arteries and veins but also the meningeal vessels and dural venous sinuses can become inflamed, occasionally resulting in hemorrhages [72][73].…”