Tuberculosis of the meninges (tuberculous meningitis)

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

Tuberculosis of meninges mostly affects children under 5 years old. Most often the disease develops during the first years after infection with the Office. About 70% of children are sick before the age of 2. In the overwhelming majority of cases (90-95%), tubercular meningitis occurs in the patient with active pulmonary or extrapulmonary tuberculosis. It can develop on the background of tuberculosis of intrathoracic lymph nodes or a primary complex complicated by hematogenous generalization. In a small number of cases, meningitis occurs in the absence of visible tubercular changes in the lungs and other organs - this is the so-called isolated primary meningitis. In addition, risk factors should be taken into account:

• age (decreased reactivity and immune defense of the body);
• seasonality (in spring and autumn there is a change in the phases of the allergic process and the reactivity of the organism):
• intercurrent and previously transmitted infections (measles, whooping cough, chicken pox, scarlet fever, flu, etc.);
• craniocerebral trauma (decreased reactivity of the brain tissue) with damage to the membranes and brain substance.

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

• prodromal period;
• period of irritation of the soft meninges;
• period of paralysis and paresis (meningoencephalitis).

The localization of specific lesions in tuberculous meningitis is a mild cerebral casing of the base of the brain (from the intersection of the visual pathways to the medulla oblongata). The process can spread to the lateral surfaces of the hemispheres, in the course of the sylvian furrows - basilar-convective meningitis.

The disease usually begins with a nonspecific inflammation, later (on average after 10 days) it passes into a specific, and develops exudative, and then an alterative-productive inflammation with the formation of caseous disease.

The central place is occupied by the defeat of cerebral vessels, mainly of 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 most often suffers.

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

Symptoms of tuberculosis of meninges

The disease most 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.

Symptoms of tuberculosis of meninges

Diagnosis of tuberculosis of meninges

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

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

• positive reactions of Pandi and Non-Apelt;
• number of cells (cytosis) 100-400 in 1 ml and above, mainly lymphocytes;
• the glucose content was reduced to 1,1-1,65 mmol / l (at a rate of 2,2-3,9 mmol / l).

When the liquor is standing for 12-24 hours, a gentle cobweb-like film falls out, in which, like in the centrifuge, mycobacteria are detected.

Diagnosis of tuberculosis of meninges