1
|
A 40-Year Old Woman With Headache. Am J Med Sci 2008; 336:418-22. [DOI: 10.1097/maj.0b013e31818803dd] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
2
|
Affiliation(s)
- G Thwaites
- Department of Microbiology, St Thomas's Hospital, London, UK.
| | | | | | | | | | | |
Collapse
|
3
|
Abstract
Tuberculosis remains one of the most common and important infectious diseases in the world. Between 1% and 2% of children with untreated tuberculosis infection will develop tuberculous meningitis. In 1997, 186 cases of tuberculous meningitis were reported in the United States. The initial clinical manifestations of tuberculous meningitis are protean, making early disease difficult to recognize. The clinical and radiographic manifestations of tuberculous meningitis result from the combination of basilar meningitis, infarction, and vasculitis. Early diagnosis can be problematic as Mycobacterium tuberculosis is difficult to detect by rapid tests. Although the response to antituberculosis chemotherapy is generally favorable, complications commonly occur, particularly if the diagnosis is delayed. With appropriate public health management of known tuberculosis cases, cases of CNS tuberculosis in children can be prevented.
Collapse
Affiliation(s)
- J R Starke
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| |
Collapse
|
4
|
Abstract
Meningitis can be subdivided based on time course of onset and duration, cerebrospinal fluid (CSF) profile, and underlying origins into acute aseptic and septic meningitis, recurrent meningitis, and chronic meningitis. These are distinct syndromes that require different management strategies. Most cases of meningitis are caused by infection. The causal agent is generally predictable based on the type of meningitis, host factors, and clues from the history and examination. CSF examination remains the critical diagnostic test.
Collapse
Affiliation(s)
- P K Coyle
- Professor, Department of Neurology, School of Medicine, State University of New York at Stony Brook, Stony Brook, New York 11794-8121, USA.
| |
Collapse
|
5
|
Lin JJ, Harn HJ, Hsu YD, Tsao WL, Lee HS, Lee WH. Rapid diagnosis of tuberculous meningitis by polymerase chain reaction assay of cerebrospinal fluid. J Neurol 1995; 242:147-52. [PMID: 7751857 DOI: 10.1007/bf00936887] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
A polymerase chain reaction (PCR) method for the rapid diagnosis of tuberculous meningitis (TBM) was used to study prospectively 47 cerebrospinal fluid (CSF) samples from 45 patients. Twenty CSF samples were from patients with clinically suspected TBM and another 27 samples came from patients without clinically suspected TBM. Mycobacterial DNA was detected in 15 CSF samples (14 from patients with clinically suspected TBM and 1 from a patient not suspected of having TBM). Of the PCR-positive samples, 4 were also positive for mycobacterial culture. However, 32 PCR-negative samples were all culture-negative. All samples were negative for the acid-fast bacillus by direct smear. The single PCR-positive patient in the clinically unsuspected TBM group was initially diagnosed as suffering from aseptic meningitis on the basis of his clinical features. The mycobacterial culture of his CSF specimen was also positive and a revised diagnosis of an aseptic type of TBM was made. The estimations of specificity and sensitivity in this study were 100% and 70% respectively. The results showed that using a PCR to detect mycobacterial DNA in CSF for the early diagnosis of TBM is not only a rapid but also an accurate method.
Collapse
Affiliation(s)
- J J Lin
- Department of Neurology, Tri-Service General Hospital No. 8, Taipei, Taiwan
| | | | | | | | | | | |
Collapse
|
6
|
Macucci M, Sità D. The cerebrospinal fluid in the diagnosis of tuberculous meningoencephalitis: review of the literature. ITALIAN JOURNAL OF NEUROLOGICAL SCIENCES 1992; 13:487-91. [PMID: 1428786 DOI: 10.1007/bf02230869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
We review the literature on the biochemical, cytological and immunological changes in the cerebrospinal fluid (CSF) in tuberculous meningoencephalitis, emphasizing the inconsistency and low specificity of the CSF findings described in classic accounts of this disease. We consider separately the possible causes of yellow or bloody fluid. The development of accurate techniques of analysis does not diminish the importance of the clinical findings and history in the early diagnosis of this disease.
Collapse
Affiliation(s)
- M Macucci
- Dipartimento di Scienze Neurologiche e Psichiatriche, Università di Firenze
| | | |
Collapse
|
7
|
Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 40-1990. A 16-year-old boy with a seizure disorder and past meningitis, current hepatic failure, and free intraperitoneal air. N Engl J Med 1990; 323:973-84. [PMID: 2169588 DOI: 10.1056/nejm199010043231407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
|
8
|
|
9
|
Chang CM, Chan FL, Yu YL, Huang CY, Woo E. Tuberculous meningitis associated with meningeal tuberculoma. J R Soc Med 1986; 79:486-7. [PMID: 3761298 PMCID: PMC1290427 DOI: 10.1177/014107688607900820] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
|
10
|
Abstract
We describe a 34-year-old man who suffered from tuberculous meningitis for 2 years without receiving antituberculous medication. Our case is compared with other forms of indolent or benign variants of the disease.
Collapse
|
11
|
Kilpatrick ME, Girgis NI, Yassin MW, Abu el Ella AA. Tuberculous meningitis--clinical and laboratory review of 100 patients. J Hyg (Lond) 1986; 96:231-8. [PMID: 3084628 PMCID: PMC2129657 DOI: 10.1017/s0022172400066006] [Citation(s) in RCA: 32] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
In developing countries tuberculous meningitis is a difficult infection to differentiate from other central nervous system (CNS) infections. This paper presents the history, physical findings, laboratory data, and clinical course of 100 patients who were admitted to a special ward and had CSF cultures positive for Mycobacterium tuberculosis. Fifty-four patients were comatose when admitted and 76 had meningeal signs. Mean admission CSF values were WBC 531, glucose 23 mg/dl, and protein 166 mg/dl. Only two CSF AFB smears were positive. Sixty-one percent of the chest X-rays taken were consistent with pulmonary tuberculous and 39% were normal. Twenty-four patients died within the first week after admission, before the clinical diagnosis was made and anti-tuberculous therapy could be started. Fifty-three of 76 patients given antituberculous therapy died. Neurologic sequelae developed in 48% of the survivors. The high mortality and morbidity rates in this patient-group were due to the severity of illness on admission and the predominance of children (54%).
Collapse
|
12
|
Abstract
Tuberculous meningitis arises from the discharge of bacilli from a subjacent caseous focus into the subarachnoid space. Meningeal involvement is most marked at the base of the brain. The clinical spectrum is very broad and the outcome of therapy depends mainly on the stage of disease at the time treatment is instituted.
Collapse
|
13
|
Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 29-1984. A 21-year-old man with headache, fever, and facial diplegia. N Engl J Med 1984; 311:172-81. [PMID: 6738603 DOI: 10.1056/nejm198407193110309] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
|
14
|
Jenik F, Tekle-Haimanot R, Hamory BH. Non-traumatic adhesive arachnoiditis as a cause of spinal cord syndromes. Investigation of 507 patients. PARAPLEGIA 1981; 19:140-54. [PMID: 7254893 DOI: 10.1038/sc.1981.31] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Spinal cord syndromes with a mainly syringomyelic pattern of sensory diorders, radiculopathies, mixed paresis of varying degree (without any history of trauma), have been found in 507 out of 1305 new patients referred to out Clinic from January 1976 till 31 October 1977. In 105 randomised and unselected cases with these syndromes, myelographies have disclosed findings compatible with an adhesive spinal and/or cisternal arachnoiditis. A prospective study of the syndromes for evidence of infectious aetiology has been performed, in which tuberculosis, syphilis and other infections appear to be causative agents. A randomised therapeutic trial on a limited number of cases has been evaluated, as well as the results of specific therapy in a larger number of cases. Results of treatment have not been satisfactory. Operations were performed on only five patients and in no case was an autopsy obtained. Spinal cord syndromes due to non-traumatic adhesive arachnoiditis are discussed. The possible pathogenetic mechanisms the predominantly syringomyelic sensory deficits in those syndromes are briefly mentioned.
Collapse
|
15
|
Abstract
Cerebral tuberculomas developed in two adult Asian immigrants during treatment for miliary tuberculosis and tuberculous meningitis. Both were infected by strains of Mycobacterium tuberculosis sensitive in vitro to all antituberculous drugs, and no evidence of immunodeficiency was detected. Focal neurological signs appeared and the lesions led to the death of one patient despite maximum treatment. The importance of systemic corticosteroids in controlling the raised intracranial pressure is discussed.
Collapse
|
16
|
Sen P, Kapila R, Salaki J, Louria DB. The diagnostic enigma of extra-pulmonary tuberculosis. JOURNAL OF CHRONIC DISEASES 1977; 30:331-50. [PMID: 326804 DOI: 10.1016/0021-9681(77)90028-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
|
17
|
Abstract
The authors describe a case of tuberculous cerebral abscess of the frontal lobe that developed 1 year after an episode of acute miliary tuberculosis. The development of such a lesion indicates a persistence of infection and an immunological breakdown which may partly have been due to protein malnutrition.
Collapse
|
18
|
Thomas DJ. Letter: Partly treated meningitis. Lancet 1974; 1:221-2. [PMID: 4129911 DOI: 10.1016/s0140-6736(74)92530-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
|