Symptoms of cerebral tuberculosis

Tuberculosis of the meninges (tuberculous meningitis) most often develops acutely. At an early age, the child cannot complain, but an attentive mother will pay attention to such harbingers of the disease as loss of appetite, increasing drowsiness, and adynamia.

In the first days of the disease, convulsions, loss of consciousness and focal symptoms of damage to the central nervous system in the form of dysfunction of the cranial nerves, paresis or paralysis of the limbs appear. Meningeal symptoms may be weakly expressed, bradycardia is absent. Stools become more frequent up to 4-5 times a day, which in combination with vomiting (2-4 times) resembles dyspepsia. At the same time, there is no exsicosis, the large fontanelle is tense, bulging. Hydrocephalus develops quickly. Sometimes the clinical picture of tuberculous meningitis in an infant is so erased that nothing can be noticed except an increase in body temperature, increasing drowsiness and adynamia. Bulging and tension of the fontanelle are of decisive importance in these cases. If the diagnosis is not made in time, the disease progresses and in 2, maximum 3 weeks leads to death.

Of the meningeal symptoms in young children, the suspension symptom (Lesage) can be used for diagnosis - a child lifted by the armpits pulls his legs up to his stomach, keeping them in a pulled-up position. The tripod symptom is characteristic - a peculiar pose in which the child sits, leaning on his hands behind the buttocks. In the prodromal period, an older child experiences general malaise, increased fatigue, loss of appetite, irritability, apathy, and intermittent headaches that intensify with bright light and noise. Body temperature during this period may be subfebrile, vomiting unrelated to food intake occasionally occurs, and a tendency to constipation is noted. The pulse at the onset of the disease may be rare (bradycardia). The prodromal period lasts from 1 to 4 weeks. It is extremely difficult to make a diagnosis during this period.

In the second period of the disease - the period of irritation of the central nervous system (8-14th day) - there is a sharp increase in all the symptoms of the prodromal period. The body temperature rises to 38-39 ° C and higher, the intensity of the headache increases, which becomes constant and is often localized in the frontal or occipital region. Vomiting appears, mostly suddenly when changing body position. Projectile vomiting is typical for tuberculous meningitis. Anorexia develops. Drowsiness and general weakness increase. Consciousness is depressed. Bradycardia is replaced by tachycardia. Constipation without bloating appears. Photophobia, noise intolerance, hyperesthesia, often pronounced vegetative-vascular disorders in the form of persistent red dermographism, as well as spontaneously appearing and quickly disappearing red spots on the face and chest (Trousseau spots) are noted. At the end of the first week of the disease (5-7th day), mild positive meningeal symptoms appear - rigidity of the occipital muscles, Kernig's and Brudzinski's symptoms. Their intensity gradually increases, and by the middle of the 2nd week of the disease, the child lies with his head thrown back, in the "cocked trigger" pose. Symptoms of cranial nerve irritation appear during the same period. The oculomotor and abducens nerves (III and VI pairs) are most often affected, which manifests itself in the form of ptosis, narrowing or dilation of the pupils, and divergent strabismus. Congestive discs are most often noted on the fundus, and later - optic neuritis. In this case, patients complain of blurred vision, fog before the eyes. As the process progresses, visual acuity may decrease, up to complete blindness. The trigeminal nerve is rarely affected, more often the facial nerve (VII pair) is affected. Impairment of the auditory nerve (VIII pair) functions manifests itself as a sensation of noise, and more often in a decrease, and occasionally in a complete loss of hearing. Disorders of vestibular functions are expressed in dizziness, a feeling of falling, and unsteadiness of gait.

When the inflammation spreads to the cerebellum and medulla oblongata (at the end of the second or beginning of the third period), the glossopharyngeal, vagus and hypoglossal nerves (IX, X, XII pairs) are involved in the process. Difficulty swallowing or choking when eating, muffled voice or dysarthria, hiccups, respiratory and cardiac rhythm disorders, etc. appear. The child's consciousness is confused, and a pronounced inhibition is noted. By the end of the second period, the child lies with his head thrown back and eyes closed, legs pulled up to the stomach, stomach pulled in, abdominal muscles tense. The third, terminal period of tuberculous meningitis also lasts about one week (14-21 days of illness). This period is characterized by the predominance of signs of encephalitis. The inflammatory process from the soft meninges spreads to the brain matter. The child's consciousness is completely lost, convulsions and tachycardia are possible. The breathing rhythm is disturbed according to the Cheyne-Stokes type. Hyperthermia is possible (up to 41 °C). Paralysis and paresis appear, usually of the central type. Hyperkinesias are combined with paralysis, which is extremely unfavorable from a prognostic point of view. By the end of the disease, cachexia develops, bedsores appear, followed by death with paralysis of the respiratory and vasomotor centers.

Spinal meningitis usually begins with symptoms of damage to the soft membranes of the brain. In the second and third periods, girdle-like pains appear in the back, chest, and abdomen, caused by the spread of the process to the radicular segment of the sensitive spinal nerves. These pains are sometimes very intense and in some cases are poorly relieved even by narcotic analgesics. As the disease progresses, pelvic disorders appear: first, difficulty urinating and persistent constipation, then - urinary and fecal incontinence. Movement disorders also appear in the form of paresis and paralysis (both central and peripheral), depending on the level of damage to the spinal cord. Such a distinction between periods is convenient when studying the clinical picture, since they reflect the development of the pathological process.

Symptoms of meningeal tuberculosis depend on the degree of damage to internal organs, age-related reactivity of the body, virulence of the microorganism and its sensitivity to the drugs used, as well as the time of treatment initiation. The prognosis for a child under 3 years of age is worse compared to an older age. With timely (up to the 10th day) long-term complex treatment, the prognosis is favorable in more than 90% of cases.

With early treatment, an improvement in well-being is noted after 1-2 weeks: headaches decrease, vomiting disappears, appetite improves. Complete normalization in most children occurs after 2-3 months of treatment. Meningeal symptoms become less intense from the 3-4th week and are completely eliminated within 2-3 months of treatment, rarely later. Disorders of the functions of the cranial nerves remain longer than meningeal symptoms. Focal symptoms of damage to the nervous system gradually disappear, but in some cases remain persistent.

During the recovery period, endocrine disorders in the form of obesity and hypertrichosis are possible; after recovery, they disappear.