Lecture subject:

TUBERCULOUS

MENINGITIS

IS A TUBERCULOSIS INFLAMMATION OF THE BRAIN TUNICS (MENINGOENCEPHALITIS) AND SPINAL CORD (SPINAL FORM OF MENINGITIS).

Risk groups for tuberculous meningitis:

1.Tender-age infants unvaccinated with BCG, from family contact, from asocial families.

2.In children, as a complication of the primary tuberculosis complex or tuberculosis of the intrathoracic lymph nodes (ILN).

3.Adults leading an asocial lifestyle.

4.Migrants.

5.Patients with progressive forms of pulmonary and extrapulmonary tuberculosis.

Clinical pucture

of tuberculous meningitis:

1.It develops gradually.

2.Prodromal period (1 - 3 weeks): malaise, lethargy, intermittent, mild headache, periodic rises in temperature to subfebrile, deterioration in mood, a decrease in interest in the outside world.

3.7 - 10 days of illness: lethargy, fever, loss of appetite, headache is more constant.

Clinical pucture

of tuberculous meningitis:

3.10 - 15 days of illness: intense headache, vomiting, lethargy increases, excitability increases, anxiety, anorexia, constipation appear. Patients quickly lose weight, temperature is 38.0 - 39.0ºC, meningeal symptoms appear, tendon reflexes are increased, pathological reflexes and disorders of craniocerebral innervation appear, paresis of the facial, oculomotor and abducens nerves, vegetative vascular disorders (persistent red dermagraphism, bradycardia, arrhythmia, hypersthenia, photophobia). The eye fundus: congestive discs of the optic nerves, tuberculous tubercles on the retina.

Clinical pucture

of tuberculous meningitis:

4. Meningeal syndrome is manifested by headache, hydrocephalus and muscle contractures due to irritation of the nerve roots.

Signs of contractures:

neck stiffness (it is impossible to bend forward with the head thrown back);

Kernig’s symptom (a patient lying on his back can’t straighten a leg bent at the hip joint at the knee joint);

Brudzinsky’s symptom (bending the head causes bending of the arms);

retraction of the abdominal muscles;

opisthotonus (position of the patient on his side with his head thrown back and legs pulled up to his stomach).

Clinical pucture

of tuberculous meningitis:

5.15 - 21 days of illness (if treatment is not started and the disease progresses): temperature 39.0 - 40.0ºC, headache and meningeal symptoms (forced posture and decerebral rigidity) become pronounced, consciousness is darkened or absent. Disorders of the craniocerebral innervation intensify, focal symptoms appear (paresis, paralysis of the limbs, hyperkinesis, automatic movements, convulsions), trophic and autonomic disorders intensify (severe sweating or dry skin, Trousseau spots, cachexia).

Clinical pucture

of tuberculous meningitis:

6.After 3-5 weeks: adynamia, indifference to the environment, confusion, soporous state, coma. The most severe in prognostic terms are lesions of the IX-XII pairs of cranial nerves with impaired swallowing, speech and the threat of death from paralysis of the respiratory center. Temperature 41.0 - 42.0ºC or below 35.0ºC. Pulse 160 - 200 beats per minute, arrhythmic breathing, such as Cheyne-Stokes breathing, then paralysis of the respiratory and vasomotor centers and death.

Clinical picture of focal brain lesions:

•Development of hemiparesis, hemiplegia.

•The lesion in the diencephalic region is accompanied by vegetative-vascular disorders in the form of vasomotor reactions, persistent red dermographism, spontaneously occurring red spots on the skin, bradycardia, tachycardia, arterial pressure lability, sleep disturbances.

COMPOSITION OF SPINAL LIQUID

(LIQUOR CEREBROSPINALIS):

FIRST WEEK OF ILLNESS:

increased pressure, clear liquid, colorless, increased protein level to 0.5–0.6 g/L, weakly positive globulin reactions, fibrin mesh does not always fall out, lymphocytic pleocytosis 100–150 cells per 1 ml, the amount of sugar or chlorides is normal (normal sugar 2.2 - 3.8 mmol/L and chlorides 120 - 128 mmol/L) or slightly reduced, MTB is found in 5 - 10% of patients.