Tb meningitis and neurocysticercosis
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Semelhante a Tb meningitis and neurocysticercosis
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Tb meningitis and neurocysticercosis
- 1. TB Meningitis and Neurocysticercosis Dr. Deepak Kumar Asst. Professor
- 4. GTCS
- 5. GTCS
- 7. Seizures Types- • Generalised onset - Diffuse involvement or large focus with surrounding edema • Focal Onset - Focus in brain • Focal onset with generalization. • Abscence type. • Myoclonic type.
- 8. Common causes • Focal Seizures- NCC, Tuberculoma, Abscess, Bleed, Malignancy • GTCS Febrile Metabolic- Sugar, Calcium,Na,Mg Encephilitis/Meningitis Epilepsy
- 10. LEARNING OBJECTIVES • CLASSIFICATION OF NEURO TB • PATHOGENESIS • SYMPTOMS AND SIGNS • COMPLICATIONS • MANAGEMENT • DIFFERENTIAL DIAGNOSIS
- 11. CLASSIFICATION • INTRACRANIAL Meninges- Meningitis Parenchyma – Encephalitis Tuberculoma Abscess Vessels - Vasculitis • Extracranial Spine- Potts spine, Tuberculoma , Abscess...
- 13. CNS TB • Most common form is TB Meningitis • Its incidence is 3% • Overall incidence of CNS TB is 1% • Mostof the time it is associated with primary TB • Most common route of spread is Lympho- Haematogenous • Morbidity and Mortality is high.
- 14. Pathogenesis
- 15. Symptoms • Age of presentation – at any age • More common between 3 to 5 years (80%) • Onset is subacute to chronic • Clinical manifestation- Three Stages
- 16. Stage 1 • Prodromal stage (2-3 weeks) • Non specific symptoms Irritability, Letharginess, Sleep disturbance Fatiguability, Headache, Vomiting
- 17. Stage 2 • Seizures • Signs of meningeal irritation • Cranial Nerve Deficit • Motor Deficit • Raised ICT • Altered Consciousness
- 18. Stage 3 • Comatose • Signs of brainstem compression Decerebrate/Decorticate • Paraplegia/paresis • Movement disorder
- 21. Complications • Hydrocephalus • Paralysis • Abnormal movements • Cranial Nerve Palsies • Hypothalamic-Pituatry-Syndrome • Opthalmic complications
- 23. Diagnosis • Clinical • Other Supportive • Lab Investigations and radiological
- 24. Supportive • Malnutrition • Immunodeficiency • Immunization Status • History of contact
- 25. Symptoms and Signs • Headache,irritability,lethargy,sleepiness • Fever, nausea, vomiting, headache • Seizures, Altered consciousness, abnormal behaviour • Fast - noisy breathing, visual disturbance development of squint, angle of mouth, difficult speech • Weakness in limbs/difficult gait
- 26. • Hydrocephalus- increase in size of head ( > 3 SD), Sun set Sign, prominent viens over head. • Fast Breathing Stridor – Raised ICT • Meningeal irritation – Brudzinski and kernigs • Cranial Nerve deficits
- 28. Modified Ahuja Criteria • Mandatory Fever > 14 days CSF Cytology – Cells > 20 ( 60% lymphos) Biochem- Protiens > 100 mg/dl Sugar < 60 mg/dl • Essentia ( atleast two ) Mantaux, Extra neural TB, Family history, Abnormal CT Findings
- 29. AIIMS Criteria • AFB (mycobacterium) in csf demonstrated • ESSENTIAL CSF- Lymphocytes > 50, Protien > 60, Sugar < 2/3rd of blood level • Supportive Mantaux, Extra neural TB, Family history, Abnormal CT Findings, Chest X ray, LDNpathy,GA AFB
- 30. CT Findings • Hydrocephalus • BASAL exudates • Gyral enhancement • Vascular enhancement • Parenchymal Infarcts • Tuberculomas, Abscess
- 32. INVESTIGATIONS
- 33. Look for TB at other sites/primary • Chest Xray • USG Abdomen • HMG with ESR • Mantaux test • Contact survey • Blood Dextrose • CSF – Cytology, Biochem, Microbio, Sero. • Neuroimaging
- 35. Baseline Investigations • LFT (before starting ATT) • KFT • Serum Electrolytes • VBG
- 36. Treatment Goals • To ensure early recovery • Minimize the neurodeficit and sequelae • To prevent transmission • To start antitubercular treatment and prevention of drug resistant • Involve other department ( Neurosurgery, Optha, Ent, physiotherapy whenever required)
- 37. Medical Management • Needs hospitalization for prolonged period • To kill bacteria and to prevent drug resistant 4 Drugs (HRZE) for 2 months 2 Drugs (HR) For 10 months • To reduce inflammation, edema, vasculitis Steroids for 6 weeks followed by tapering
- 38. • Intracranial Hypertension to be managed using – mannitol , glycerol and 3% Nacl • Seizures – According to the Cause PHENOBARBITONE NOT TO BE USED • Hydrocephalus Acetazolamide to reduce CSF production CSF Shunts
- 39. TUBERCULOMA
- 40. • Tuberculoma is a cluster of micro granulomas which coalesce into mature non-caseating granulomas in any organ • Single lesion is common than multiple • Located at any site, can be supratentorial or infratentorial
- 41. Presentation • Siezures usually partial type • Without signs of meningeal irritation • Neurodeficit – paresis, plegias • Raised ICT usually present due to mass effect • Symptoms as per the location- Brain stem syndromes Cerebellitis
- 42. Diagnosis • Clinical • Imaging • Response to therapy SECTL ( Single Enhancing CT Lesion) D/D – Tuberculoma, NCC, Fungal , Toxoplasmic, Metastatic lesion, Abscess
- 43. Clinical Criteria • Seizure should be initial symptom • No features of persistent raised ICT • No h/o progressive neurodeficit • No h/o active systemic disease Radiological Criteria • Will be discussed with NCC
- 45. Prevalance • Most common infection of CNS by parasites. • Most frequent preventable cause of epilepsy • Affects 50 million people worldwide. • 50,000 deaths in highly endemic places.
- 46. Epidemic factors – Egg contamination of grass and soil – Method of raising domestic animals – Unhygienic dinning habit of eating raw or undercooked meat
- 47. PRESENTATION The clinical presentation of NC is determined by • Location of cysts • Size of cysts • number of cysts • Host’s immune response
- 48. Anatomical Classification • Parenchymal NC • Intraventricular NC • Meningeal NC • Spinal NC • Ocular NC Nelson
- 49. CLINICAL SIGNS • Acute symptomatic seizures are the most common manifestation of human NCC; • The other clinical conditions include – headache, hydrocephalus, chronic meningitis, focal neurological deficits, psychological disorders, dementia • Ocular symptoms- pain,blurring,vision loss
- 50. DDX: Tuberculoma Versus Cysticercus Granuloma Cysticercus Granuloma • Round in shape • Cystic • 20mm or less with ring enhancement or visible scolex • Cerebral edema not enough to produce midline shift or focal neurological deficit Tuberculoma • Irregular in shape • Solid • Greater than 20mm • Associated with severe perifocal edema and focal neurological deficit
- 52. TREATMENT • Praziquantel three doses of 25-30 mg/kg at 2- hour intervals on a single day equally effective to the 50mg/kg 8 hourly dose for 15 days. • Albendazole 15mg/kg/day in 2 divided doses for 1 week equally effective to the 15 mg/kg/day 12 hrly for 28 days.
- 53. Thank you