Meningeal TB

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This is one of the most common presentations of TB among older people in the US who had been exposed to TB earlier in their lives. When a reactivation of the TB takes place there is a high fever coupled with an severe headache. If not diagnosed, the symptoms will very quickly progress to drowsiness and coma. One of the complications can be thrombosis of one of the major blood vessels in the brain, which would mimic a stroke like picture. The neurologist can do a diagnostic lumbar puncture. This would show a glucose content of less than 50% of the serum glucose level, protein elevation and lymphocytic cells in the cerebrospinal fluid (CSF).

A commercial test using polymerase chain reaction to TB exists, which will be positive on this CSF sample. This test is rapid and specific for TB.

Anti-TB therapy using a multidrug combination chemotherapy as mentioned above can lead to a complete cure, provided the diagnosis was made early enough. Occasionally a brain abscess (here in an AIDS patient) is found in the work-up of meningeal TB . A neurosurgeon should then be consulted to decide whether or not this should be removed while the patient is covered with antituberculous drug therapy. These cases and menigeal TB are more frequent among AIDS patients. There are also more TB brain abscess cases among IV drug users in recent years.

 

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Disclaimer

This outline is only a teaching aid to patients and should stimulate you to ask the right questions when seeing your doctor. However, the responsibility of treatment stays in the hands of your doctor and you.

References

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Last Modified: Feb. 10, 2012