Tuberculosis of the cerebral membranes (tuberculous meningitis)

Tuberculous meningitis is more common in children and adolescents than in adults. It is usually secondary, developing as a complication of tuberculosis of another organ (lungs, bronchial or mesenteric lymph nodes) with subsequent hematogenous dissemination and damage to the meninges.

Tuberculosis of the meninges affects mainly children under 5 years of age. Most often, the disease develops during the first years after infection with MBT. About 70% of children fall ill before the age of 2. In the vast majority of cases (90-95%), tuberculous meningitis occurs in a patient with active pulmonary or extrapulmonary tuberculosis. It can develop against the background of tuberculosis of the intrathoracic lymph nodes or a primary complex complicated by hematogenous generalization. In a small number of cases, meningitis occurs in the absence of visible tuberculous changes in the lungs and other organs - this is the so-called isolated primary meningitis. It is also necessary to take into account the risk factors:

• age (reactivity and immune defense of the body decreases);
• seasonality (in spring and autumn there is a change in the phases of the allergic process and the body's reactivity):
• intercurrent and previously suffered infections (measles, whooping cough, chickenpox, scarlet fever, influenza, etc.);
• traumatic brain injury (decreased reactivity of brain tissue) with damage to the membranes and substance of the brain.

For timely diagnosis, it is necessary to remember that in the course of tuberculous meningitis in the absence of treatment, three periods can be distinguished:

• prodromal period;
• period of irritation of the pia mater;
• period of paralysis and paresis (meningoencephalitis).

Localization of specific lesions in tuberculous meningitis is the soft meninges of the base of the brain (from the optic chiasm to the medulla oblongata). The process can spread to the lateral surfaces of the hemispheres, along the Sylvian fissures - basilar-convexital meningitis.

The disease usually begins with non-specific inflammation, later (on average after 10 days) it turns into specific inflammation, with exudative inflammation developing, and then alterative-productive inflammation with the formation of caseosis.

The central place is occupied by the defeat of cerebral vessels, mainly veins and arteries of small and medium caliber according to the type of peri- or panvasculitis with thrombosis. Of the large arteries, the middle cerebral artery is most often affected.

There are three main forms of tuberculosis of the meninges: basilar meningitis, meningoencephalitis and the spinal form.

Symptoms of tuberculosis of the meninges

The disease 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.

Symptoms of tuberculosis of the meninges

Diagnosis of tuberculosis of the meninges

If meningitis is suspected, that is, in the presence of fever, persistent headaches that increase in intensity, meningeal syndrome and miliary dissemination in the lungs, a lumbar puncture is indicated.

The nature of the cerebrospinal fluid in tuberculosis of the meninges in children is as follows:

• positive Pandy and None-Apelt reactions;
• cell count (cytosis) 100-400 in 1 ml and higher, mainly lymphocytes;
• glucose content is reduced to 1.1-1.65 mmol/l (with the norm being 2.2-3.9 mmol/l).

When the cerebrospinal fluid stands for 12-24 hours, a delicate web-like film falls out, in which, as in the centrifugate, mycobacteria are found.

Diagnosis of tuberculosis of the meninges