Tuberculous Meningitis, Meningitis is a complication of childhood TB More common at the age of 6 and 24 months of age There is usually a focus of primary infection or miliary tuberculosis. If untreated, high frequency of neurological sequelae and mortality occurs.

1. PATHOGENESIS AND CLINICAL
FEATURES OF TB MENINGITIS
-S.ROHINI

2. Tuberculous Meningitis,
Meningitis is a complication of childhood TB
More common at the age of 6 and 24 months of age
There is usually a focus of primary infection or miliary
tuberculosis.
If untreated, high frequency of neurological sequelae and
mortality occurs.

3. PATHOGENESIS:
Mycobacterium tuberculosis enter lungs via
droplet inhalation
During the stage of lung invasion, a transient
bacteraemia occurs, which results in seeding of
bacilli in meninges and brain parenchyma.
Tuberculous inf. reaches meninges by
hematogenous route or by lymphatics

4. Tubercular bacilli affect end arteries and forms sub-
meningeal tubercular foci (Rich foci).
Increase in size of Rich foci occurs until it rupture
into subarachnoid space.
Tubercle bacilli discharges into subarachnoid space intermittently,
which proliferates and cause perivascular exudation followed by
caseation, gliosis and giant cell formation.

6. PATHOLOGY
The meningeal surfaces and ependyma are inflamed and covered with
yellow grayish exudates and tubercles.
These are more common at the base, in
the region of temporal lobe and along
course of middle cerebral artery.

7.  The subarachnoid space and arachnoid villi are obliterated
results in poor absorption of CSF, resulting in hydrocephalus.
 Cerebral edema may be present.
 Choroid plexus is congested, edematous and studded with
tubercles.
 There may be infarcts in the brain due to vascular occlusion

9. CLINICAL FEATURES:
There are 3 stages
• Stage of invasion (prodromal stage)
• Stage of meningitis
• Stage of coma

10. STAGE OF INVASION(PRODROMAL STAGE):
Insidious onset with low grade fever
Loss of appetite
Disturbed sleep
Child is irritable, peevish and restless
Frequent vomiting
Headache(in case of older children)
Child may exhibit head banging and photophobia

11. STAGE OF MENINGITIS:
• Neck rigidity is present
• Kernig sign is positive
• Fever may be remittent or intermittent
• Pulse is slow but regular
• Muscle tone is increased
• Disturbed breathing
• Drowsy and delirious
• Convulsions
• Sphincter control is lost

12. STAGE OF COMA:
• Loss of consciousness
• Rise of temperature
• Pupils dilated, unequal, with nystagmus
and squint
• Ptosis, ophthalmoplegia
• Cheyne-stokes or biot type breathing
• Bradycardia

13. • Hemiplegia, quadriplegia, cranial nerve palsies, decerebrate rigidity.
• Some shows monoplegia, hemiballismus, tremors, decorticate rigidity.
If untreated death occurs in about four weeks.

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