What Is Tuberculous Meningitis? By Krishan B Kumar At Isnare.com Ezine Articles

Meninges, i.e. thin layers/membranes (3 in number, named from outside to inside, (i) the dura mater, (ii) the arachnoid mater and (iii) the pia mater) covering the brain may also be involved as a result of tuberculosis, and the disease is called tuberculous meningitis. In this case, the infection spreads from the brain to the meninges. Initially, a slow-growing tuberculous lesion called 'tuberculoma' develops in the brain, adjacent to the meninges, which ruptures in the subarachnoid space, i.e., the space between the second and third layer/meninx, causing infection of the meninges, leading to the signs and symptoms of tuberculous meningitis.

It was sometimes thought that there is a true entry of the tubercle bacilli from this 'tuberculoma' into the subarachnoid space. The author discussed this aspect in detail with related case reports, with Dr. William Boyd (Canada), a renowned pathologist, who has also written Text Book of Pathology as well as Pathology for the Physician. In one of his communications to the author, while finally approving that there is indeed a rupture of tuberculoma into the subarachnoid space, he wrote, "Needless to say, I was most interested in your case of focal epilepsy followed by tuberculous meningitis. It seems to me that your idea of a tuberculoma rupturing and discharging bacilli into the subarachnoid space is the most reasonable one". In the case of the patient, discussed with Dr. Boyd, the patient developed focal epilepsy as a result of tuberculoma in the brain, and thus primarily presented the signs and symptoms of epilepsy, and later, as a case of tuberculous meningitis after the probable rupture of tuberculoma into the subarachnoid space.

An early diagnosis and treatment of tuberculous meningitis is most important in order to save the patient from various neurological deficits. It should be treated as a medical emergency. A delay in treatment could result in permanent disabilities. Initially, the patient gets vague symptoms like malaise, loss of appetite, a vague headache, irritability, and soon he gets the so-called symptoms and signs of meningial irritation, as a result of the tuberculous infection of the meninges, like a persistent headache, vomiting, neck rigidity / stiffness, etc. Stiffness of the neck is a valuable sign of this disease, and the rigidity of the neck gives the clinical clue to the diagnosis of tuberculous meningitis. Another important sign is that the patient cannot extend the leg after the thigh has been flexed, or brought close to the abdomen (called Kernig's sign). Of course, this is usually elicited by the physicianl neurologist while examining the case in detail.

It is important to recognize all the early signs and symptoms of tuberculous meningitis before the disease advances. All the relevant tests must be carried out to locate the lesion of tuberculosis in other parts of the body, especially in the lungs. An examination of the cerebrospinal fluid (CSF), including the computed tomographic (CT) scanning of the head, is also required for the diagnosis of tuberculous meningitis. Once diagnosed, the patient should be immediately put on suitable antituberculosis treatment in proper dosages, for a suitable period, so as to eradicate the infection of tuberculosis from the brain.

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