Tubercular meningitis
Contents:
see also:
- Pulmonary tuberculosis
- Tuberculosis
- Tuberculosis cutis
- Tubercular intoxication
- To show all list
Description:
Hematogenous dissimination of MBT in a nervous system, in the structures surrounding a head or spinal cord causes meningitis.
Tubercular meningitis is an inflammation of a meninx. To 80% of patients with tubercular meningitis have or signs of the tuberculosis of other localizations postponed earlier, or active tuberculosis of other localization at the moment.
Symptoms of Tubercular meningitis:
Meningitis children, especially chest early age have preferential, is much more rare - adults.
On localization allocate the main forms of tubercular meningitis: basilar meningitis; encephalomeningitis; spinal meningitis.
Distinguish 3 periods of development of tubercular meningitis:
1) prodromal;
2) irritations;
3) terminal (paresis and paralyzes).
The prodromal stage is characterized gradual (during 1-8 weeks) by development. At first there are a headache, dizziness, nausea, sometimes vomiting, fever. The ischuria and a chair is observed, temperature subfebrile, is more rare - high. However cases of a course of a disease are known and at a normal temperature.
Irritation period: in 8-14 days after a prodrome there is sharp strengthening of symptoms, the body temperature of 38-39 °C, pain in frontal and occipital area of the head. Drowsiness, slackness, consciousness oppression increase. A lock without swelling - a scaphoid abdomen. Photophobia, skin hyperesthesia, intolerance of noise. Vegetovascular frustration: a resistant red dermographism, spontaneously appear and quickly red spots on face skin and a breast disappear.
At the end of the first week of the period of irritation (for the 5-7th day) there is indistinctly expressed meningeal syndrome (a stiff neck, a Kernig's sign and Brudzinsky).
Characteristic manifestations of symptoms appear in the second period of irritation depending on localization of inflammatory tubercular process.
At an inflammation of meningeal covers headaches, nausea and a stiff neck are observed.
At accumulation of serous exudate in the basis of a brain there can be an irritation of cranial nerves with the following signs: deterioration in sight, blepharoplegia, squint, unequally mydriatic pupils, deafness. Hypostasis of a nipple of an eyeground is present at 40% of patients.
Involvement of brain arteries in pathological process can lead to an alalia or weakness in extremities. At the same time any area of a brain can be damaged.
At hydrocephaly of various degree of manifestation there is a blocking exudate of some cerebrospinal connections with a brain. Hydrocephaly - the main reason of a loss of consciousness. Pathological manifestations can be constants and point to the bad forecast for the patients who are in unconsciousness.
At blockade of a spinal cord weakness of motor neurons or paralysis of the lower extremities can arise exudate.
Terminal period (period of paresis and paralyzes, 15-24th day of a disease). In a clinical picture symptoms of encephalitis prevail: lack of consciousness, tachycardia, Cheyna-Stokes's breath, body temperature is 40 °C, paresis, paralyzes of the central character.
At a spinal form in the 2nd and 3rd periods the surrounding, very severe radicular pains, sluggish paralyzes, decubituses are observed.
Reasons of Tubercular meningitis:
In the bodies affected with tuberculosis (easy, lymph nodes, skin, bones, kidneys, intestines, etc.) the specific "cold" tubercular inflammation having preferential granulematozny character and leading to formation of multiple hillocks with tendency to disintegration develops.
Tubercles can become the reason:
1. inflammations of meningeal covers;
2. formations of gray jellylike weight in the brain basis;
3. inflammations and narrowings of the arteries conducting to a brain which in turn can become the reason of local brain disturbance.
Treatment of Tubercular meningitis:
If there is a suspicion on existence of the tubercular meningitis sick it is necessary to hospitalize urgently in specialized medical institution in which can be executed X-ray inspection, a spinal puncture, laboratory inspection, specific methods of antitubercular therapy are applied.
In the absence of treatment outcome lethal. Than earlier the diagnosis is made and treatment is begun, the consciousness of the patient at the time of an initiation of treatment is clearer, the forecast is better.
