Akademik Veri Yönetim Sistemi
INTERNATIONAL NEUROLOGICAL EMERGENCY SYMPOSIUM, 07 Aralık 2021
Introduction
Tuberculous meningitis (TBM) is the form of extrapulmonary tuberculosis with the highest morbidity
and mortality rates. It most frequently develops with subependymal tubercles rupturing into the
subarachnoid space. Tuberculosis bacilli can lead to TBM as a result of hematogenous spread from the
primary focus in the pulmonary, peribronchial, and peritracheal regions. Meningeal involvement is more
frequently seen in the basal part of the brain. It is most common at the ages of 0-4 years. In adults, it is
most frequently seen between 15 and 25 years. The most important prognostic marker is the patient’s
state of consciousness at the start of treatment. Complications and mortality increase in case of delay.
Mycobacterium tuberculosis must be considered in patients presenting with a clinical manifestation of
meningitis. We present the following case to emphasize the importance of early diagnosis and treatment.
Case
A 22-year-old woman complained of headache for the previous 13 days. Body temperature elevation
and nausea/vomiting had also been present for the last four days. Meningeal irritation evidence was
positive. Direct examination of cerebrospinal fluid (CSF) collected through lumbar puncture revealed
100/ mm3 lymphocyte and 80/mm3 leukocyte counts. CSF biochemistry was reported as microprotein:
167 mg/dl; glucose: 21 mg/dl, and chlorine: 107 mg/dl.
The patient was hospitalized to our ward and started on ceftriaxone, dekort, and mannitol.
Antituberculosis therapy was initiated on the following day. Tuberculosis PCR was positive. The
symptoms resolved during follow-up. Mycobacterıum tuberculosis growth was determined in
tuberculosis culture. The patient’s general condition improved, and she was discharged with oral steroid
and antituberculosis therapy.
Conclusion
TBM must be included in the differential diagnosis of patients presenting with a clinical manifestation
of meningitis in regions where tuberculosis is endemic, particularly in case of accompanying chronic
complaints. Antituberculosis therapy must be initiated as early as possible in order to reduce mortality
and morbidity.
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