The neurocritical care of tuberculous meningitis

Publication date: Available online 17 May 2019Source: The Lancet NeurologyAuthor(s): Joseph Donovan, Anthony Figaji, Darma Imran, Nguyen Hoan Phu, Ursula Rohlwink, Guy E ThwaitesSummaryTuberculous meningitis is the most severe form of tuberculosis and often causes critical illness with high mortality. Two primary management objectives are reducing intracranial pressure, and optimising cerebral perfusion, while killing the bacteria and controlling intracerebral inflammation. However, the evidence base guiding the care of critically ill patients with tuberculous meningitis is poor and many patients do not have access to neurocritical care units. Invasive intracranial pressure monitoring is often unavailable and although new non-invasive monitoring techniques show promise, further evidence for their use is required. Optimal management regimens of neurological complications (eg, hydrocephalus and paradoxical reactions) and of hyponatraemia, which frequently accompanies tuberculous meningitis, remain to be elucidated. Advances in the field of tuberculous meningitis predominantly focus on diagnosis, inflammatory processes, and antituberculosis chemotherapy. However, clinical trials are required to provide robust evidence guiding the most effective supportive, therapeutic, and neurosurgical interventions for tuberculous meningitis that will improve morbidity and mortality.
Source: The Lancet Neurology - Category: Neurology Source Type: research

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ConclusionsNeurologists and (neuro-)radiologists should be familiar with the neuroradiological presentation and the clinical course of CNS TB to ensure timely diagnosis and treatment.
Source: Clinical Neuroradiology - Category: Neurology Source Type: research
In conclusion, the diagnosis of TBM should combine clinical manifestations, CSF examination and the effect of anti-TB therapy. Differential diagnosis and trial anti-TB therapy may be of help for diagnosis. Positive CSF smear, CSF culture and biopsy of the brain, or biopsy of meninges are golden standards for the diagnosis of TBM. Early diagnosis and treatment are very important for improving the outcome. PMID: 30210618 [PubMed]
Source: Experimental and Therapeutic Medicine - Category: General Medicine Tags: Exp Ther Med Source Type: research
We describe a case of an Italian child. Diagnoses: we diagnosed early a Tuberculous meningitis complicated by the occurrence of hydrocephalus, stroke, and paradoxical reaction with brain pseudo-abscesses. Interventions: The child started readily a specific therapy associated with steroids and thalidomide was introduced few month later. Outcomes: the patient had a favorable outcome without neurologic sequelae. Lessons: Despite the prompt specific anti-tubercular and adjuvant corticosteroid therapies, only the addition of thalidomide to the treatment allow to a favorable clinical outcome.
Source: Medicine - Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research
LITFL • Life in the Fast Lane Medical Blog LITFL • Life in the Fast Lane Medical Blog - Emergency medicine and critical care medical education blog aka Tropical Travel Trouble 008 Peer Reviewer Dr McBride ID physician, Wisconsin TB affects 1/3rd of the population and one patient dies every 20 seconds from TB. Without treatment 50% of pulmonary TB patients will be dead in 5 years. In low to middle income countries both TB and HIV can be ubiquitous, poor compliance can lead to drug resistance and malnourished infants are highly susceptible. TB can be very complex and this post will hopefully give you the backbone t...
Source: Life in the Fast Lane - Category: Emergency Medicine Authors: Tags: Clinical Cases Tropical Medicine Genexpert meningitis TB TB meningitis Tuberculosis Source Type: blogs
Semin Neurol 2018; 38: 226-237 DOI: 10.1055/s-0038-1651500Central nervous system (CNS) involvement of tuberculosis (TB) is the most severe manifestation of TB and accounts for approximately 5 to 10% of all extrapulmonary TB (EPTB) cases and approximately 1% of all TB cases. TB meningitis (TBM) is the most common form of CNS TB, though other forms occur, often in conjunction with TBM, including intracranial tuberculomas, tuberculous brain abscesses, and spinal tubercular arachnoiditis. CNS TB often presents with nonspecific clinical features that mimic symptoms of other neurological conditions, often making diagnosis diffic...
Source: Seminars in Neurology - Category: Neurology Authors: Tags: Review Article Source Type: research
Conclusions The surgical outcomes of both TBM and TBS still poor in many ways. Improving TB outcomes as implementation of the End TB Strategy program at 2030 remain our homework.
Source: Interdisciplinary Neurosurgery - Category: Neurosurgery Source Type: research
In conclusion, old age and hydrocephalus are the predictors for poor prognosis of TBM. Patients with these risk factors should be treated promptly with a special care paid to improve their outcomes.
Source: Medicine - Category: Internal Medicine Tags: Research Article: Observational Study Source Type: research
Objective:To describe the incidence, mortality, and neurological complications of tuberculous meningitis (TBM) in the US between 1993 through 2013.Background:Incidence of tuberculosis has decreased in the US over the past two decades, but it is uncertain whether incidence of TBM has similarly declined.Design/Methods:Using the Nationwide Inpatient Sample, we identified all adult patients hospitalized with TBM during the study period using ICD-9-CM diagnosis codes. Incidence rates were calculated after adjusting for annual US Census population estimates. We then calculated the rate of neurological complications and mortality...
Source: Neurology - Category: Neurology Authors: Tags: Infectious Disease: HIV, Syphilis, Borrelia, TB, Cysticercosis, and Other Infections Source Type: research
Conclusions:TB meningitis is a severe and frequently fatal cause of meningitis and vasculopathy. While well characterized and often on the initial differential for chronic meningitis, it is rarely encountered as a cause of acute meningitis in an immunocompetent population in the US. In this particular case rapid progression and likely secondary vasculopathy with brainstem infarcts precluded timely diagnosis and directed treatment.Disclosure: Dr. Utigard has nothing to disclose. Dr. Katyshev has nothing to disclose. Dr. Isada has nothing to disclose. Dr. Dani has nothing to disclose.
Source: Neurology - Category: Neurology Authors: Tags: Autoimmunity with Infection, Syphilis, Lyme, Tuberculosis, and other Bacteria Source Type: research
Authors: Li K, Tang H, Yang Y, Li Q, Zhou Y, Ren M, Long X, Shen W, Hu R, Wang XF, Zeng K Abstract BACKGROUND: Tuberculosis is prevalent in China, which is the second greatest contributor to the global tuberculosis burden. Tuberculosis meningitis (TBM) is the most severe disease form but few reports describe long-term clinical outcomes and prognostic factors. Thus, we studied these features in Chinese TBM patients. METHODS: A retrospective follow-up study was used to collect clinical features and outcomes of adult TB meningitis at the First Affiliated Hospital of Chongqing Medical University from June 2012 to A...
Source: Expert Review of Anti-Infective Therapy - Category: Infectious Diseases Tags: Expert Rev Anti Infect Ther Source Type: research
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