Symptoms
The main symptoms of tuberculous meningitis are similar to those of meningitis of other etiologies. A sick person develops general weakness, malaise, may have headaches, muscle pain - these are common symptoms. The fever gradually increases, however, with the tuberculous nature of the process, the increase occurs slowly, over 1-2 weeks.
At the height of the fever, a person develops meningeal symptoms: tension (stiffness) of the neck muscles, severe headaches that are not relieved by painkillers, and vomiting may develop at the height of the headache.
Gradually, all cognitive functions of a person are impaired, consciousness becomes clouded, and sensitivity to light and sound develops. Severe tuberculous meningitis can quickly lead to death. An untreated process leads to death in almost 100% of cases within a month from the onset of the disease.
Tuberculous meningitis: symptoms
In most cases, the disease gradually manifests itself with clinical signs, but sometimes acute progressive forms of tuberculous meningitis can be found.
The first signs of the disease are a deterioration in general health, headache, lethargy, lack of appetite, and an increase in body temperature to 380C. Then the headaches intensify and become permanent. The patient begins to suffer from bouts of vomiting, constipation, a feeling of anxiety, and weight loss is observed. Paresis of the oculomotor, abducens and facial nerves appears.
Patients diagnosed with tuberculous meningitis are characterized by photophobia, arrhythmia, and bradycardia (decrease in heart rate less than 60 beats per minute). The disease is accompanied by changes in the eyes: tuberculous tubercles appear, which are recognized by a phthisiatrician, and inflammation of the optic nerves is also noted.
In the absence of adequate treatment, after two weeks the patient’s body temperature rises to 400C. At the same time, the patient continues to suffer from headaches. There is also clouding of consciousness, paralysis and paresis, convulsions, tachycardia, dry skin and significant weight loss. In the absence of treatment, death occurs after 5-6 weeks due to paralysis of the vasomotor and respiratory centers.
When the first symptoms of pathology appear, you must urgently seek medical help. Neurologists, therapists, infectious disease specialists and other doctors at the Yusupov Hospital are ready to provide assistance or consultation to the patient at any time.
The most common type is basal tuberculous meningitis. This form is manifested by pronounced cerebral meningeal symptoms. That is, the patient is not able to touch his chest with his chin; he has disturbances in tendon reflexes and cranial innervation.
The most severe form of the disease is tuberculous meningoencephalitis. In this case, there are both cerebral symptoms (vomiting, headache, confusion) and meningeal, focal symptoms (paralysis of the limbs, unsteadiness of gait, etc., depending on the area and extent of damage to brain cells). Hydrocephalus and disorders of cranial innervation may develop.
Diagnostics
Diagnosis of the disease is quite difficult; it is carried out mainly on the basis of a neurological examination and analysis of cerebrospinal fluid. The neurological status reveals symptoms of inflammation of the meninges (Kernig's, Brudzinski's symptoms of various levels, stiffness of the neck muscles, etc.). If a person has tuberculous meningitis, his cerebrospinal fluid acquires characteristic properties:
- Increased cerebrospinal fluid pressure.
- Protein-cell dissociation with an increase in protein levels (mainly fibrin up to 5-10 grams per liter, and cells up to several hundred). It is noteworthy that in the first few days the basis of the cells is represented by neutrophils, and only then by lymphocytes (a characteristic sign of the tuberculous nature of the process).
- Reduced glucose levels by 40-50%, reduced chloride and sodium levels in small quantities.
- Often, a day after the collection of cerebrospinal fluid, a fibrin mesh forms in the test tube. Often the amount of protein is so large that the cerebrospinal fluid immediately coagulates.
- When inoculating the cerebrospinal fluid with special cultures, colonies of tubercle bacilli are obtained.
There is a point of view in which any meningitis with fever of moderate intensity, an unclear picture of the cerebrospinal fluid, should be considered tuberculous and treated as this particular pathology. This opinion is justified, because in 30% of cases the rod is not sown, and accurate diagnosis leads to a delay in the process and increases the risk of complications.
Description and causes of tuberculous meningitis
The disease is characterized by the presence of an inflammatory process in the membranes of the brain caused by mycopathogens of tuberculosis. The pathology has an acute course, occurs abruptly and proceeds rapidly. The patient suffers from high fever, pain, and neurological dysfunction.
Tuberculous meningitis (TM) was first described in clinical theory in the late 19th century. The separation of pathology into a separate category occurred after the discovery of tuberculosis bacteria in the brain fluid of patients exhibiting meningeal symptoms. The disease was initially thought to exclusively affect children and adolescents. In recent decades, symptoms have increasingly appeared in the adult population. A predisposition to TM has been identified in people with a reduced immune response as a result of damage to the body by the immunodeficiency virus, changes in alcoholism and drug addiction, and in adulthood.
The vast majority of patients suffer from secondary meningitis, which developed against the background of primary tuberculosis damage to organs (mainly the lungs). In cases where the underlying cause cannot be detected, it is customary to diagnose an isolated form of TM. In the first option, bacteria penetrate the fibers of the brain or spinal cord from the respiratory, reproductive, and skeletal systems; primary damage to the kidneys, larynx, etc. is possible. The rarest cause is infection through contact with a sick person.
Pathogens spread throughout the body's structures through the blood or lymph. Against the background of reduced immunity, the protective barrier becomes thinner, mycobacteria first penetrate microscopic vessels, through them into soft fibers and nerve cells. The anomaly is most often localized at the base of the brain. Serous-fibrinous tubercles form in the affected areas, and the inflammatory process can spread to other parts of the brain. In the affected area, blood channels become inflamed and clogged, and nerve cells die. During restoration, the tissue is not restored, being replaced by connecting elements - scars, adhesions. The disease in childhood leads to excessive accumulation of fluid in the brain cavities (hydrocephalus).
Treatment
Therapy for the disease should begin in the first days of the onset of the disease. It should be noted that treatment of tuberculous meningitis must begin with anti-tuberculosis drugs, and not with antibiotics. For the first two weeks, 4 drugs should be combined, gradually, when the symptoms are relieved, the inflammatory process is relieved, switch to 3 drugs, continuing therapy for up to 2-3 months.
Symptomatic treatment methods are the fight against meningeal edema (mannitol), neuroprotective therapy, and restorative treatment. In severe cases and early development of convulsive syndrome, anticonvulsant drugs should be used in addition to treatment.
Diagnostic methods
When meningeal signs appear, the disease is diagnosed by a phthisiatrician working together with a neurologist. After the initial examination and history taking, instrumental research manipulations are prescribed:
- Lumbar puncture. The cerebrospinal substance is collected. Already at the intake stage, anomalies such as increased flow pressure are noted. The liquid sometimes flows out in a stream with increased pressure. The color of the substance is unchanged, transparency is maintained. During laboratory studies, an increased content of cellular elements may be observed against the background of a decrease in the content of sugar and chloride compounds. The lower the glucose content in the solution, the more serious the diagnostic indicator of the disease. A typical sign is the separation of an arachnoid film when the liquid settles for 1-2 days. The analysis also shows a large amount of protein in the solution. The tuberculosis bacillus can be detected in 10 cases out of a hundred. In spinal pathology, the substance has a yellowish tint. The pressure during leakage changes little, the cellular content is increased, and the level of sugars decreases.
- Computer scanning. It is carried out with the aim of separating the nature of the disease from other forms of meningeal syndrome. Tomography helps determine the extent of damage to the brain areas and determine the chemical component of the abnormal area. Experts are able to distinguish purulent forms of meningitis and encephalitis, the complicated course of other infections from the tuberculosis variant of the anomaly.
- Magnetic resonance screening (tomography) of the brain. It is also carried out for the purpose of differentiating the disease. The scans of the device clearly show the boundaries of the lesion, the degree of destruction of the nervous tissue, scar formations, compactions, and areas of fluid accumulation.
At the first signs of pathology, it is necessary to identify the pathogenic factor and the level of the disorder as soon as possible, since the subsequent spread of aggressive bacteria leads to irreversible consequences. If a specialist refers you to hardware diagnostics (CT, MRI), an emergency examination is necessary. In the capital, hundreds of diagnostic centers operate in this area, distributed throughout all districts of the city.
To quickly find the nearest medical facility, a single city resource Mrt-v-msk has been created. The portal pages contain a complete list of clinics that perform computer tomography or magnetic resonance imaging. Users of the site have the opportunity to compare clinic ratings and prices for services in one list, read reviews of patients who have undergone diagnostics, and obtain information about working specialists. To receive detailed advice and sign up for a procedure at the selected center, you can use the hotline number located at the top of the portal page. Consultation and registration for scanning are free of charge.
Consequences and prognosis
Tuberculous meningitis, the consequences of which can be expressed in convulsive syndrome, intracranial hypertension, disturbances in the functioning of the sensory organs, proceeds favorably only with timely treatment. The prognosis of tuberculous meningitis is generally positive and usually ends without any significant consequences.
However, the very fact of meningitis indicates a low level of immunity, the probable presence of HIV in the AIDS stage, as well as the extensiveness of the tuberculosis process, which in itself very often leads to death.
The annual diagnostic measures for tuberculosis infection (fluorography) should be taken as seriously as possible, and the identified process should be treated comprehensively and fully. Indeed, unfortunately, very often patients with this insidious infection come from low strata of society and, as a rule, do not undergo full treatment, which takes months or even years, and ultimately remain a source of infection for other people.
