Convulsions in tuberculous meningitis

Abstract

One-hundred-and-thirty-six children below 12 years of age hospitalized with a diagnosis of tuberculous meningitis (TBM) have been investigated to identify the underlying cause of convulsions. One-hundred-and-one children (74 per cent) presented with seizures before and/or during hospitalization. Generalized tonic and clonic seizures (GTCS) were the commonest (58 per cent) type of seizures followed by focal seizures (FS) (38 per cent) and tonic spasms (TS) (4 per cent). EEG changes were more frequently observed in cases with FS and in those children with GTCS who presented after first week of hospitalization. EEG findings included generalized dysrythmia with paroxysmal slow activity (38 per cent), interhemispheric asymmetry (23 per cent), multiple spike and wave pattern (10 per cent), and focal spike and wave pattern (15 per cent). CT scan findings were more common in those children with GTCS and TS who presented with recurrent seizures and/or seizures manifesting after first week of hospitalization. FS presenting at any stage of the disease were associated with CT scan abnormalities. Abnormalities detected in CT scan of brain included meningeal enhancement (55 per cent), hydrocephalus (32 per cent), tuberculomas (27 per cent), and cerebral infarctions (13 per cent). Clinical presentation and investigations indicate that the probable cause of convulsions could be attributed to cerebral edema (57 per cent), syndrome of inappropriate secretion of antidiuretic hormone (35 per cent), hydrocephalus (32 per cent), tuberculoma (27 per cent), abnormal electric focus (25 per cent), and cerebral infarction (13 per cent).

Tuberculous meningitis

“…In pediatric patients coma, raised intracranial pressure, seizures and focal neurological deficits dominate the clinical manifestations. Generalized tonic and clonic seizures are the commonest type of seizures followed by focal seizures and tonic spasms (44). Hyponatremia in patients with tuberculous meningitis is a common metabolic abnormality.…”

Triphasic waves in a patient with tuberculous meningitis

“…The EEG findings included generalized dysrhythmia with paroxysmal slow activity (38%), interhemispheric asymmetry (23%), multiple spike and wave patterns (10%), and focal spike and wave patterns (15%) [21]. Misra U. K. et al reported abnormal EEGs in 33 out of 44 TBM patients, with diffuse background slowing in 22 cases, frontal intermittent delta activity in 12 cases, and epileptiform discharges in 2 cases.…”

Tuberculous meningoencephalitis in HIV-seronegative patients: variety of clinical presentation and impact on diagnostics and treatment

“…TBM is a very rare disease in Western European countries with a wide heterogeneity of clinical symptoms and potential pitfalls in diagnostic investigations. Therefore, TBM might be underestimated in its frequency of occurrence, all the more since all clinical symptoms are unspecific and to be found in several infectious diseases (10). Since a secure diagnosis TBM cannot be made on the basis of clinical symptoms alone, additional diagnostic techniques play an essential role.…”