<p><b>Tuberculous meningitis:</b> <a href="http://www.medicinenet.com/script/main/art.asp?articlekey=10375">Meningitis</a> due to <a href="http://www.medicinenet.com/script/main/art.asp?articlekey=505">tuberculosis</A>. Tuberculous meningitis is the most severe form of tuberculosis. It causes severe neurologic deficits or <a href="http://www.medicinenet.com/script/main/art.asp?articlekey=33438">death</a> in more than half of cases.
<p>The pattern of tuberculous meningitis in the population is different in different areas of the world. In areas with much tuberculosis, tuberculous meningitis usually affects young children. It develops typically 3 to 6 months after the <a href="http://www.medicinenet.com/script/main/art.asp?articlekey=12237">primary</a> tuberculosis infection. By contrast, in areas with less tuberculosis, tuberculous meningitis tends to strike adults. It may follow a primary infection but, more frequently, is due to reactivation of an old focus of tuberculosis that had been dormant, sometimes for many years.</p>
<p>Tuberculois meningitis begins insidiously with a gradual fluctuating <a href="http://www.medicinenet.com/script/main/art.asp?articlekey=3425">fever</a>, <a href="http://www.medicinenet.com/script/main/art.asp?articlekey=9879">fatigue</a>, weight loss, behavior changes, <a href="http://www.medicinenet.com/script/main/art.asp?articlekey=20628">headache</A>, and vomiting. This early phase is followed by neurologic deficits, loss of consciousness, or convulsions. A dense gelatinous <a href="http://www.medicinenet.com/script/main/art.asp?articlekey=9900">exudate</a> (outpouring) forms and envelops the brain arteries and <a href="http://www.medicinenet.com/script/main/art.asp?articlekey=7576">cranial nerves</a>. It creates a bottleneck in the flow of the <a href="http://www.medicinenet.com/script/main/art.asp?articlekey=7529">cerebrospinal fluid</A>, which leads to <a href="http://www.medicinenet.com/script/main/art.asp?articlekey=9089">hydrocephalus</A>. The development of arteritis and infarctions of the brain can cause <a href="http://www.medicinenet.com/script/main/art.asp?articlekey=3686">hemiplegia</a> or <a href="http://www.medicinenet.com/script/main/art.asp?articlekey=5165">quadriplegia</a>.</p>
<p> A high index of suspicion is essential to diagnose the disease because early diagnosis is the key to a satisfactory outcome. If tuberculous meningitis is seriously suspected, treatment should start immediately. Treatment involves <a href="http://www.medicinenet.com/script/main/art.asp?articlekey=2698">chemotherapy</a> to control and eradicate the infection, management of hydrocephalus and elevated <a href="http://www.medicinenet.com/script/main/art.asp?articlekey=13759">intracranial</a> pressure, and immunomodulation with <a href="http://www.medicinenet.com/script/main/art.asp?articlekey=2849">corticosteroids</a> (cortisone-like drugs such as prednisone).
<p>The <a href="http://www.medicinenet.com/script/main/art.asp?articlekey=11087">World Health Organization</a> (WHO) recommends a two-month intensive course of isoniazid, rifampin, pyrazinamide, and ethambutol followed by 4 months of isoniazid and rifampin. Elevated intracranial pressure can be life-threatening. The hydrocephalus may require placement of a ventriculoperitoneal <a href="http://www.medicinenet.com/script/main/art.asp?articlekey=5488">shunt</a>. The use of the <a href="http://www.medicinenet.com/script/main/art.asp?articlekey=2849">corticosteroid</a> dexamethasone improves survival in patients over 14 years of age but probably does not prevent severe disability.</p><br><br><a href="http://www.medterms.com/script/main/hp.asp">MedTerms</a> (TM) is the Medical Dictionary of <a href="http://www.medicinenet.com/script/main/hp.asp">MedicineNet.com</a>.<br>We Bring Doctors' Knowledge To You
