Tuberculous meningitis in native Dutch children: A report of four cases

Abstract

Although it is believed that in the western countries tuberculosis is a disease confined to high-risk groups such as immigrants, we describe four cases of tuberculous meningitis (TBM) in native Dutch children. The inverse relation between the delay in starting therapy and the clinical outcome makes early diagnosis of TBM essential. The often non-specific presenting symptoms and laboratory results, the time-consuming character of cultures and the unfamiliarity of western medical staff with the disease all may contribute to a delay in diagnosis of TBM. We believe that especially gadolinium-enhanced MRI or contrast-enhanced CT can be very helpful in the early diagnosis. Although not specific, hydrocephalus and basal meningeal enhancement on MRI or CT, together with the clinical suspicion can suggest the diagnosis to such an extent that there is enough reason to start antituberculous treatment.

Clinical and laboratory characteristics of cerebral infarction in tuberculous meningitis: A comparative study

“…[19][20][21] However, the value of meningeal enhancement in this context remains controversial. Kingsley et al 21 suggested that the severity of TB meningitis was not related to the degree of meningeal enhancement.…”

Tuberculosis of the central nervous system: overview of neuroradiological findings

“…Currently, polymerase chain reaction in CSF can diagnose TBM with a higher sensitivity than microscopic examination and cultures; however, its full use for the diagnosis of TBM is limited by the lack of standardization and availability [4]. Even though there are no specific radiological characteristics of TBM, neuroimaging can be helpful in the early diagnosis [9].…”

“…Tuberculous meningitis (TBM) is undoubtedly the most common presentation of neurotuberculosis and occurs predominantly in young children and adolescents [9]. Pathologically, this granulomatous infection of the leptomeninges (arachnoid membrane and pia mater) is characterized by a thick exudate most notably affecting the basal portions of the brain [10,11,12].…”

Effects of TENS and methylphenidate in tuberculous meningo-encephalitis

“…Compared to HSE, tuberculous meningitis (TBM) produces an even more generalized and severe neurological pattern, mostly related to hydrocephalus, followed by infarction in preferably the right basal ganglia and in the areas innervated often by the right middle cerebral artery [29]. More specifically, in several cases, CT demonstrated abnormalities in the right frontal lobe, right or bilateral temporal lobes and right or bilateral basal ganglia [30].…”