A 45 year old man was admitted with a 3 day history of coma following 2 weeks of headache and fever. Examination revealed a GCS of 8/15, neck stiffness, and a complete R oculomotor nerve palsy. Examination of the CSF showed an opening pressure of 20 cmH2O, 800 leucocytes.mm3 (30% neutrophils, 70% lymphocytes), protein 180 mg/dl, CSF/ blood glucose 0.18. Gram and Ziehl-Neelsen stains of the CSF were negative. Culture of the CSF on Lowenstein Jensen media grew Mycobacterium tuberculosis.
(Adapted from Practical Neurology 2002)
This type of scenario can come out in the Part 1 or 2a MRCP and medical student exams. Not possible for PACES.
Name 3 complications of TB meningitis that may need neurosurgical intervention.
8 comments:
Hydrocephalus, Syringomyelia, tuberculoma??
Brain abscess, Coning resulted from increase ICP, hydrocephalus
1}Syringomyelia.
2}Tuberculoma.
3}Hydrocephalus.
Abscess, Tuberculoma and hydrocephalus
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