Symptoms of tuberculosis of the meninges

Tuberculosis of the meninges (tuberculous meningitis) often develops sharply. At an early age a child can not make complaints, but a careful mom will pay attention to such precursors of the disease, as a decrease in appetite, increasing drowsiness, adynamy.

In the first days of the disease, convulsions, frustration of consciousness and focal symptoms of central nervous system damage appear in the form of impairment of the functions of the cranial nerves, paresis or paralysis of the limbs. Meningeal symptoms can be expressed weakly, a bradycardia is absent. The chair becomes more frequent 4-5 times a day, which, in combination with vomiting (2-4 times), resembles dyspepsia. At the same time there is no excision, a large fontanel is tense, bulging. Hydrocephalus is developing rapidly. Sometimes the clinical picture of tuberculous meningitis in a breastfed child is so rubbed that nothing can be seen, other than a rise in body temperature, increasing drowsiness and adynamia. The decisive importance in these cases is the bulging and tension of the fontanelle. If the diagnosis is not timely delivered, the disease progresses and after 2, a maximum of 3 weeks leads to death.

From meningeal symptoms in young children can be used to diagnose the symptom of suspension (Lesage) - raised by the armpit child pulls his legs to the stomach, keeping them in a tightened position. The symptom of the tripod is characteristic - a peculiar pose, in which the child sits, leaning on the hands behind the buttocks. In the prodromal period, the child of the older age has a general malaise, increased fatigue, loss of appetite, irritability, apathy, a fickle headache that intensifies in bright light and noise. The temperature of the body during this period may be subfebrile, occasionally there is vomiting, not associated with eating, note a tendency to stool. Pulse at the onset of the disease can be rare (bradycardia). The prodromal period is from 1 to 4 weeks. During this period, it is extremely difficult to diagnose.

In the second period of the disease - the period of irritation of the central nervous system (8-14 day) - there is a sharp increase in all the symptoms of the prodromal period. The body temperature rises to 38-39 ° C and above, the intensity of the headache increases, which becomes constant and is often localized in the frontal or occipital region. Vomiting occurs, mostly suddenly when the position of the body changes. For tuberculous meningitis, vomiting is typical of a fountain. Anorexia develops. Drowsiness and general weakness increase. Consciousness is oppressed. Bradycardia is replaced by tachycardia. There is constipation without bloating. They noted photophobia, intolerance to noise, hyperesthesia, often expressed vegetative-vascular disorders in the form of persistent red dermographism, as well as spontaneously emerging and rapidly disappearing red spots on the face and chest (Tricso patches). At the end of the first week of the illness (5-7th day), mild positive positive meningeal symptoms appear - stiff neck muscles, symptoms of Kernig and Brudziński. Their intensity gradually increases, and by the middle of the second week of illness the child lies with his head thrown back, in the "cocked-cocked" attitude. In the same period, symptoms of irritation of the cranial nerves appear. The most commonly affected oculomotor and nerve (III and VI pairs), which manifests itself in the form of ptosis, narrowing or widening of the pupils, divergent strabismus. On the fundus note most often stagnant discs, and later - neuritis of the optic nerves. In this case, patients complain of blurred vision, fog before the eyes. With the progression of the process, it is possible to reduce visual acuity, up to complete blindness. The trigeminal nerve rarely suffers, the facial nerve is more affected (VII pair). Violation of the functions of the auditory nerve (VIII pair) manifests itself in the form of a sensation of noise, and more often in a decrease, occasionally in complete loss of hearing. Disorders of vestibular functions are expressed in dizziness, sensation of falling, instability of gait.

In the spread of inflammation to the cerebellum and medulla oblongata (at the end of the second or the beginning of the third period), the linguopharyngeal, wandering and sublingual nerves (IX, X, XII pairs) are involved in the process. There is a difficulty swallowing or shuffling with food, muffled voice or dysarthria, hiccups, a breakdown in the rhythm of breathing and cardiac activity, etc. The consciousness of the child is confused, they note a pronounced inhibition. By the end of the second period the child lies with his head thrown back and his eyes closed, his legs are pulled to the stomach, the stomach is drawn in, the abdominal muscles are strained. The third, terminal, period of tuberculous meningitis also lasts about one week (14-21 days of illness). For this period, the predominance of signs of encephalitis is characteristic. The inflammatory process from the soft meninges extends to the substance of the brain. Consciousness in the child is completely lost, cramps, tachycardia are possible. The rhythm of breathing is disturbed by the Cheyne-Stokes type. Possible hyperthermia (up to 41 ° C). There are paralysis, paresis, usually the central type. 1perkinesis combined with paralysis, which is prognostically extremely unfavorable. By the end of the disease, cachexia develops, bedsores appear, followed by death at the phenomena of paralysis of the respiratory and vasomotor centers.

The spinal form of meningitis, as a rule, begins with the symptoms of the defeat of the soft shells of the brain. In the second and third periods, shingles 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 controlled even by narcotic analgesics. With the progression of the disease there are disorders of the functions of the pelvic organs: firstly difficulty urination and persistent constipation, in the future - incontinence of urine and feces. There are also motor disorders in the form of paresis and paralysis (both central and peripheral), depending on the level of damage to the spinal cord. Such allocation of periods is convenient in the study of the clinical picture, as they reflect the development of the pathological process.

The symptoms of tuberculosis of the meninges depend on the degree of damage to the internal organs, the age-related reactivity of the organism, the virulence of the microorganism and its sensitivity to the drugs used, as well as the start of treatment. The prognosis of a child under the age of 3 years is worse, compared with the older age. With a timely (before the 10th day) long-term comprehensive treatment, the prognosis is favorable in more than 90% of cases.

With early treatment after 1-2 weeks, they notice improvement in well-being: headache decreases, vomiting disappears, appetite improves. Complete normalization in most children occurs after 2-3 months of treatment. Meningeal symptoms become less intense from the 3rd-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 the defeat of the nervous system gradually disappear, but in some cases remain persistent.

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