Tuberculous Meningitis

Tuberculous Meningitis: Overview

Tuberculous meningitis (TBM) is a severe form of tuberculosis (TB) infection that affects the central nervous system, most commonly the brain and spinal cord. It can cause a wide variety of neurological problems, including seizures, stroke, and mental changes.

People with TBM usually develop symptoms gradually over weeks or months. They may have fever, headache, vomiting, neck stiffness, confusion, seizures, and altered mental status. Other symptoms may include stiff neck, sleepiness, drowsiness, confusion, changes in behavior and personality, difficulty concentrating, muscle weakness, and vision and hearing problems.

TBM is a medical emergency and requires prompt diagnosis and treatment. Treatment typically consists of antibiotics and medications to help control symptoms and prevent complications. Without treatment, the condition can be fatal after about six weeks.

Causes

TBM is caused by infection with the bacterium Mycobacterium tuberculosis, which is found in the environment (most commonly in the soil) and is spread through the air when someone with TB coughs, sneezes, or speaks. People can scavenge lung TB infection through inhalation of droplets containing M. tuberculosis, which is then transported via the blood vessels to the central nervous system. Approximately 4 to 5% of people with treated TB infection will get TBM.

People at risk for TBM include those with HIV/AIDS, individuals with weakened immune systems, people who live in overcrowded or unsanitary living conditions, and healthcare workers exposed to TB.

Diagnosis

TBM is diagnosed based on the patient's symptoms, medical history, physical exam, imaging studies (such as computed tomography scans and magnetic resonance imaging scans), and laboratory tests. These tests may include a lumbar puncture to look for abnormal proteins or white blood cells in the spinal fluid.

Treatment

TBM is treated with a combination of antibiotics and other medications. The type and length of treatment will depend on the patient's overall health, bacterial resistance, and other factors. In most cases, treatment must be continued for at least 12 months.

Medications used to treat TBM may include:

• Antibiotics: These are used to kill the bacteria causing the infection.
• Corticosteroids: These can help reduce inflammation in the brain to reduce pressure, reduce the risk of seizure, and improve symptoms such as headache.
• Anticonvulsants: These can help control or prevent seizures.
• Medications to improve fluid drainage in the brain: These help reduce pressure on the brain caused by fluid buildup.
• Pain relievers: These can help reduce headaches.

In some cases, surgery may be needed to repair damaged tissue or to help drain fluid from the brain and reduce pressure.

Complications

TBM can cause a wide range of complications, including:

• Seizures
• Stroke
• Hearing or vision problems
• Memory and concentration problems
• Trouble understanding language, speaking, or reading
• Spinal cord injury
• Coma
• Death