COMPOSITION OF SPINAL LIQUID

(LIQUOR CEREBROSPINALIS):

SECOND WEEK OF DISEASE:

during puncture, CSL flows out in frequent drops, the pressure is increased to 300-500 mm. WG, the liquid becomes opalescent, the protein level is increased to

1.0 - 2.0 g/L and higher, sharply positive globulin reactions, a delicate fibrin film in the form of a grid falls out during the day, lymphocytic-neutrophilic pleocytosis, less often neutrophilic-lymphocytic, 200 - 700 cells per 1 ml, the sugar level is reduced to 1.5 - 1.6 mmol/L and chlorides to 100 mmol/L, MTB is found in

10 - 20% of patients. Positive samples of Pandi and Nonne-Apelt reactions are noted.

COMPOSITION OF SPINAL LIQUID (LIQUOR CEREBROSPINALIS):

THIRD WEEK OF ILLNESS:

xanthochromia, jelly-like consistency of the liquid, reduced sugar levels (sometimes up to 0 mmol/L) and chlorides, protein-cell dissociation (protein level up to 3.0 - 5.0 g/L and even 300 g/L), with a lower neutrophilic - lymphocytic or neutrophilic pleocytosis 2000 - 15000 cells in 1 ml.

CLINICAL FORMS OF TUBERCULOUS

LESIONS OF BRAIN TUNICS:

1.BASAL (BASILAR) TUBERCULOUS MENINGITIS:

localized on the tunics of the base of the brain. The CSL composition corresponds with the first week of illness. The course of the disease is smooth, without exacerbations, the outcome is a complete recovery. Improvement in condition after 3-4 weeks, disappearance of meningeal symptoms after 2-3 months, sanitation of CSL after 4-5 months. The course of treatment is 10-12 months.

CLINICAL FORMS OF TUBERCULOUS LESIONS OF BRAIN TUNICS:

2.TUBERCULOUS MENINGOENCEPHALITIS:

localized on the tunics of the base of the brain, extends to its substance and blood vessels. The composition of the CSL corresponds to 2 weeks of illness. The course of the disease is severe, protracted with exacerbations, the outcome is recovery with complications. Improvement and disappearance of meningeal symptoms after 2-3 months, sanitation of CSL after 5-6 months. The course of treatment is 12 - 14 months.

CLINICAL FORMS OF TUBERCULOUS LESIONS OF BRAIN TUNICS:

3.TUBERCULOUS CEREBROSPINAL

LEPTOPACHYMENINGITIS (TUBERCULOUS

MENINGOENCEPHALOMYELITIS):

localized on the tunics of the base of the brain, the shells of the medulla oblongata and spinal cord. The composition of CSL corresponds with the third week of illness, nexanthochromic. The course of the disease is less severe than meningoencephalitis. Outcome - recovery often without complications. The course of treatment is 12-15 months with the use of corticosteroid hormones orally, and sometimes endolumbally.

PECULARITIES OF TUBERCULOUS MENINGITIS IN CHILDREN AND TEENAGERS:

1.Brain tunics tuberculosis affects children mainly under 5 years of age.

2.Initial symptoms: loss of appetite, increasing drowsiness, adynamia.

3.During the first days of illness:

convulsions;

disorder of consciousness;

focal symptoms of CNS damage in the form of dysfunction of the cranial nerves, paresis or paralysis of the limbs;

meningeal symptoms may be mild;;

PECULARITIES OF TUBERCULOUS MENINGITIS IN CHILDREN AND TEENAGERS:

there is no bradycardia;

defecation becomes more frequent up to 4-5 times a day, which in combination with vomiting (2-4 times) resembles dyspepsia;

there is no exsicosis, a large fontanel is tense, swells;

rapidly developing hydrocephalus;

sometimes the clinical picture of tuberculous meningitis in an infant is so erased that nothing else but an increase in temperature, increasing drowsiness and weakness can be noticed; in these cases, the bulging and tension of the fontanel becomes decisive;

PECULARITIES OF TUBERCULOUS

MENINGITIS IN CHILDREN AND

TEENAGERS:

if the diagnosis is not made in a timely manner, the disease progresses and after 2, maximum 3 weeks leads to death;

concerning the meningeal symptoms in young children, the “suspension” (Lesage) symptom is characteristic: the child raised by the armpits pulls his legs to the stomach, keeping them in a bent position, and the “tripod” symptom is a peculiar posture in which the child sits, leaning on his hands behind the buttocks;

PECULARITIES OF TUBERCULOUS MENINGITIS IN CHILDREN AND TEENAGERS:

4.in the second period of the disease, meningeal symptoms appear and increase, signs of damage to the cranial nerves (usually pairs III and VI);

5.in older children, tuberculous meningitis proceeds in the same way as in adults;

6.the prognosis in a child under the age of 3 years is worse compared to an older age;

7.with timely (up to 7-10 days, even during the exudative phase of inflammation) long-term complex treatment, the prognosis is favorable in more than 90% of cases;

8.brain tuberculomas in children in most cases remain very small and do not cause an increase in intracranial pressure, but can cause characteristic local symptoms with signs of a volumetric lesion.

IT’S IMPORTANT TO CONSIDER

THE FOLLOWING:

1.Anamnesis (information about contact with patients with tuberculosis).

2.The nature of tuberculin tests, the timing of revaccination (considering that in a serious condition of the child they can be negative).

3.Clinical manifestations (the nature of the onset and development of meningitis, the state of consciousness, the severity of meningeal symptoms).

4.Chest X-ray data: detection of active tuberculosis or residual changes in past tuberculosis.