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Colegio de Medicos y Cirujanos República de Costa Rica

2019, Number 627

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Rev Med Cos Cen 2019; 85 (627)

Tuberculosis meníngea

Valle SJ, Romero SA

Language: Spanish
References: 22
Page: 34-39
PDF size: 110.73 Kb.


ABSTRACT

Background: Central Nervous System (CNS) Tuberculosis (TB) is one of the less frequent forms of extrapulmonary TB, however, it is one of the most devastating forms with high morbidity and mortality. It represents about 8% of all extrapulmonary cases that occur in immunocompetent individuals and mortality is estimated at 15-40%.
Methodology / Results: We present the case of a 29-year-old female, with no pathological personal history, with a subacute headache and constitutional symptoms, who associates dysarthria and disorientation. At 24 hours after admission, left hemiparesis and a third left cranial nerve are documented. A molecular study of CSF by M. tuberculosis was carried out, which is positive. Immediatly started antibiotic treatment associated with steroids but during evolution, it associates hydrocephalus as an expected complication, requiring a derivation of CSF.
Conclusions: The initial clinical picture of this pathology is nonspecific, characterized by constitutional symptoms, the most frequent symptoms being fever, headache, vomiting, altered state of consciousness and cervical stiffness. In more advanced stages of the disease, cranial nerve involvement (III, IV, VI), focal deficits and visual loss are frequent. The diagnosis is suspected in the case of chronic lymphocytic meningitis, marked hypoglycorrhachia, requiring visualization of the smear, demonstration of mycobacterial nucleic acids or isolation of the microorganism by culture. Imaging studies help in the assessment of differential diagnosis and complications. The treatment with antifimics consists of a 4-drug phase for 2 months and a 2-drug phase for 7 months..


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