Paroxysmal sympathetic hyperactivity syndrome in tuberculous meningitis with paradoxical reaction

Siahaan, Andre Marolop Pangihutan; Tandean, Steven; Indharty, Rr Suzy; Nainggolan, Bahagia Willibrodus Maria; Susanto, Martin

doi:10.1016/j.ijscr.2022.107619

Cited by 2 publications

(1 citation statement)

References 40 publications

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“…We reviewed 16 cases of pathogenic negative tuberculous meningitis since 2020 [ 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 ] (see Supplementary Table S4 ). These case reports are similar to our cases, mainly because of their atypical clinical manifestations or lesion sites, such as one-and-a-half syndrome [ 35 ], nonconvulsive status epilepticus [ 36 ], oculomotor palsy [ 38 ], lesions involving clivus [ 31 ], and midbrain [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical Management of Pathogen-Negative Tuberculous Meningitis in Adults: A Series Case Study

Huang

et al. 2022

JCM

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Tuberculosis remains a serious world public health problem. Tuberculous meningitis (TBM) is the one of most severe forms of extrapulmonary tuberculosis. However, the insensitivity and time-consuming requirement of culturing the pathogen Mycobacterium tuberculosis, the traditional “gold standard” diagnostic test for TBM, often delays timely diagnosis and treatment, resulting in high disability and mortality rates. In our series case study, we present five pathogen-negative TBM cases who received empirical anti-tuberculosis therapy with a good clinical outcome. We describe in detail the clinical symptoms, laboratory test results, and imaging findings of the five patients from symptom onset to dynamic follow-up. We then summarize the similarities of the clinical characteristics of the presented patients, as well as shared features in laboratory and imaging tests, and proceed to analyze the challenges in the timely diagnosis of TBM. Finally, we argue that monitoring of cerebrospinal fluid markers and imaging are critical for the diagnosis and treatment of TBM, and emphasize the importance of differential diagnosis in cases when tuberculous meningitis is highly suspected despite negative findings for that etiology.

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Section: Discussionmentioning

confidence: 99%

Clinical Management of Pathogen-Negative Tuberculous Meningitis in Adults: A Series Case Study

Huang

et al. 2022

JCM

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Paroxysmal Sympathetic Hyperactivity in Childhood Tuberculous Meningitis: A New Association

Jauhari,

Singh,

Jain

et al. 2024

J Child Neurol

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Background We sought to estimate the prevalence and clinical characteristics of paroxysmal sympathetic hyperactivity (PSH) in childhood tuberculous meningitis. Methods Hospital records of children (6 months to 14 years) with tuberculous meningitis were retrospectively analyzed from September 2019 through January 2022. In September 2019, the first case of paroxysmal sympathetic hyperactivity in tuberculous meningitis was identified in our division. Since then, all admitted children with tuberculous meningitis have been screened for paroxysmal sympathetic hyperactivity using the Paroxysmal Sympathetic Hyperactivity Assessment Measure (PSH-AM). Paroxysmal sympathetic hyperactivity is suspected when any of the following are present: recurrence of fever after initial defervescence, episodic posturing, dystonia, or unexplained tachycardia. Outcome at 3 months was prospectively scored according to the Pediatric Cerebral Performance Category score. Results Forty-one hospital records of children with tuberculous meningitis were analyzed, and 6 of them had paroxysmal sympathetic hyperactivity (probable paroxysmal sympathetic hyperactivity, 5/6; possible paroxysmal sympathetic hyperactivity, 1/6). Paroxysmal sympathetic hyperactivity appeared after a mean duration of 17 weeks (range: 12-25 weeks) from the diagnosis of tuberculous meningitis in 4 of 6 children and at 4 weeks in 2 of 6 children. Children with tuberculous meningitis who developed paroxysmal sympathetic hyperactivity were younger (median age: 5 years) compared with the nonparoxysmal sympathetic hyperactivity tuberculous meningitis cohort (median age: 10 years). A high proportion of children who developed paroxysmal sympathetic hyperactivity had hydrocephalus at presentation (5 of 6 [83.3%] vs 12 of 35 [34.3%], P = .035). Hospital stay was significantly prolonged in children with probable paroxysmal sympathetic hyperactivity (mean: 71.2 ± 26.8 days) compared with tuberculous meningitis without paroxysmal sympathetic hyperactivity (mean: 20.8 ± 11.6 days; P < .0001). Conclusion Paroxysmal sympathetic hyperactivity is a late complication of tuberculous meningitis observed in 14.6% cases and should be anticipated in children with reappearance of fever or neurologic worsening without any apparent cause.

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Paroxysmal sympathetic hyperactivity syndrome in tuberculous meningitis with paradoxical reaction

Cited by 2 publications

References 40 publications

Clinical Management of Pathogen-Negative Tuberculous Meningitis in Adults: A Series Case Study

Clinical Management of Pathogen-Negative Tuberculous Meningitis in Adults: A Series Case Study

Paroxysmal Sympathetic Hyperactivity in Childhood Tuberculous Meningitis: A New Association

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