![Page 1: Tuberculosis Meningitis 10 April, 2009. Ⅰ Ⅰ overview TBM is the most serious type in children with tuberculosis TBM is an early primary complications](https://reader035.vdocuments.site/reader035/viewer/2022070323/56649e245503460f94b12012/html5/thumbnails/1.jpg)
Tuberculosis Meningitis
10 April, 2009
![Page 2: Tuberculosis Meningitis 10 April, 2009. Ⅰ Ⅰ overview TBM is the most serious type in children with tuberculosis TBM is an early primary complications](https://reader035.vdocuments.site/reader035/viewer/2022070323/56649e245503460f94b12012/html5/thumbnails/2.jpg)
Ⅰ Ⅰ overview
TBM is the most serious type in children
with tuberculosis
TBM is an early primary complications in
Primary tuberculosis
the incidence is significantly decreased
after BCG vaccination
![Page 3: Tuberculosis Meningitis 10 April, 2009. Ⅰ Ⅰ overview TBM is the most serious type in children with tuberculosis TBM is an early primary complications](https://reader035.vdocuments.site/reader035/viewer/2022070323/56649e245503460f94b12012/html5/thumbnails/3.jpg)
Ⅱ Epidemiology
Age of Onset : More common in 1 ~5 year-old 1180 TBM in Beijing Children's Hospital<3y 56.7% , <1y 48.5% (half the number) Onset in Season : common in Winter or spri
ng
![Page 4: Tuberculosis Meningitis 10 April, 2009. Ⅰ Ⅰ overview TBM is the most serious type in children with tuberculosis TBM is an early primary complications](https://reader035.vdocuments.site/reader035/viewer/2022070323/56649e245503460f94b12012/html5/thumbnails/4.jpg)
Ⅲ Ⅲ PPathogenesis
Hematogenous dissemination : blood-CSF path main
Brain , meningeal tuberculosis rupture secondly
Tuberculosis in nearly organize direct spread occasionally
![Page 5: Tuberculosis Meningitis 10 April, 2009. Ⅰ Ⅰ overview TBM is the most serious type in children with tuberculosis TBM is an early primary complications](https://reader035.vdocuments.site/reader035/viewer/2022070323/56649e245503460f94b12012/html5/thumbnails/5.jpg)
Ⅳ Ⅳ Pathology Extensive lesions Lesions in the bases of skull “basilar meningitis”basilar meningitis” (most
obvious) 病变以脑底部脑底部最明显 “脑底脑膜炎” leptomeningeal hyperemia, edema, Inflammatory exudat
e The inflammatory exudate is accumulated in the subarac
hnoid ( cistern in pavimentum cerebri ) cranial nerve lesion cerebrovascular disorder 。 Pyocephalus and Hydrocephalus 。 Tuberculoma
![Page 6: Tuberculosis Meningitis 10 April, 2009. Ⅰ Ⅰ overview TBM is the most serious type in children with tuberculosis TBM is an early primary complications](https://reader035.vdocuments.site/reader035/viewer/2022070323/56649e245503460f94b12012/html5/thumbnails/6.jpg)
Ⅴ Ⅴ Clinical manifestation
Most typical cases ----slow onset
Generalsymptom
Tuberculosis toxic symptom
meningeal irritation sign cranial nerve lesion irritative or destructive symptoms of encephalon intracranial hypertension spinal cord disorder symptom
nervous systemsymptom
![Page 7: Tuberculosis Meningitis 10 April, 2009. Ⅰ Ⅰ overview TBM is the most serious type in children with tuberculosis TBM is an early primary complications](https://reader035.vdocuments.site/reader035/viewer/2022070323/56649e245503460f94b12012/html5/thumbnails/7.jpg)
prodromal period( prophase )
meningeal irritation period
( metaphase )coma period
( advanced stage )
•Tuberculosis toxic symptom•Headache•vomiting•Personality change
•intracranial hypertension•meningeal irritation sign•cranial nerve lesion•irritative or destructive symptoms of encephalon•pyramid sign;pyramidal sign•convulsion
•symptom increased •go into coma•spinal cord dysfunction
ⅤⅤClinical manifestation
![Page 8: Tuberculosis Meningitis 10 April, 2009. Ⅰ Ⅰ overview TBM is the most serious type in children with tuberculosis TBM is an early primary complications](https://reader035.vdocuments.site/reader035/viewer/2022070323/56649e245503460f94b12012/html5/thumbnails/8.jpg)
Ⅵ Ⅵ DiagnosesDiagnoses
(Ⅰ)(Ⅰ)HistoryHistory :: Age, Seasons, History of exposure and BCG vaccination,History of exposure and BCG vaccination, History of infectious diseasesHistory of infectious diseases
(Ⅱ)(Ⅱ)clinical featureclinical feature ::
![Page 9: Tuberculosis Meningitis 10 April, 2009. Ⅰ Ⅰ overview TBM is the most serious type in children with tuberculosis TBM is an early primary complications](https://reader035.vdocuments.site/reader035/viewer/2022070323/56649e245503460f94b12012/html5/thumbnails/9.jpg)
((ⅢⅢ)) CSF ExaminationCSF Examination ::
1 、 routine : Appearance : Like ground-glass , floccule or membran
e High pressure
Cell count ( Lymphocytes ): 50 ~ 500×106/L
2 、 biochemistry : Protein 、 glucose and chloride
3 、 film preparation : precipitum acid-fast stain positive 30%
![Page 10: Tuberculosis Meningitis 10 April, 2009. Ⅰ Ⅰ overview TBM is the most serious type in children with tuberculosis TBM is an early primary complications](https://reader035.vdocuments.site/reader035/viewer/2022070323/56649e245503460f94b12012/html5/thumbnails/10.jpg)
(Ⅲ)(Ⅲ) CSF ExaminationCSF Examination :: 3 、 Others 1 ) tubercle bacillus antigen detection 2 ) anti-tuberculosis antibody ( one of the early diagnosis evidence ) 3 ) adenosine deaminase ( ADA ) activity TBM : ADA >9μ/L 4 ) immunoglobulin : IgG 5 ) detect DNA fragment 6 ) tubercle bacillus culture film preparation and cultivation --- may be have a clear diagnosis
![Page 11: Tuberculosis Meningitis 10 April, 2009. Ⅰ Ⅰ overview TBM is the most serious type in children with tuberculosis TBM is an early primary complications](https://reader035.vdocuments.site/reader035/viewer/2022070323/56649e245503460f94b12012/html5/thumbnails/11.jpg)
((ⅣⅣ)) X-ray examinationX-ray examination Chest X-ray: About 85% have tuberculose focus ((Ⅴ)CT or MRIⅤ)CT or MRI early: normal progression : Shadow of the basal ganglia enhance
d, cistern density , fuzzy, calcification, ventricular dilatation, cerebral edema or infarct foci
((ⅥⅥ)) PPD-TestPPD-Test
![Page 12: Tuberculosis Meningitis 10 April, 2009. Ⅰ Ⅰ overview TBM is the most serious type in children with tuberculosis TBM is an early primary complications](https://reader035.vdocuments.site/reader035/viewer/2022070323/56649e245503460f94b12012/html5/thumbnails/12.jpg)
a. Transverse T1W image after contrast administration reveals ringlike enhancement in occipital region and abnormal enhancement of the ependymal of the ventricles
b. coronal T1W image of same patient(同一病人的冠状面 T1W )
枕区环形强化灶
侧脑室室管膜异常增强
侧脑室明显扩大
![Page 13: Tuberculosis Meningitis 10 April, 2009. Ⅰ Ⅰ overview TBM is the most serious type in children with tuberculosis TBM is an early primary complications](https://reader035.vdocuments.site/reader035/viewer/2022070323/56649e245503460f94b12012/html5/thumbnails/13.jpg)
Ⅶ Ⅶ Differential DiagnosisDifferential Diagnosis
1 、 purulent meningitis 2 、 Viral Encephalitis 3 、 Cryptococcus neoformans meningi
tis 4 、 cerebral abscess
![Page 14: Tuberculosis Meningitis 10 April, 2009. Ⅰ Ⅰ overview TBM is the most serious type in children with tuberculosis TBM is an early primary complications](https://reader035.vdocuments.site/reader035/viewer/2022070323/56649e245503460f94b12012/html5/thumbnails/14.jpg)
Ⅷ treatment(Ⅰ) General treatment bed rest Nutrition Nursing Care Coma Patients : nasogastric feeding 、 pressure sore prevention attention Water-Electrolyte Balance
![Page 15: Tuberculosis Meningitis 10 April, 2009. Ⅰ Ⅰ overview TBM is the most serious type in children with tuberculosis TBM is an early primary complications](https://reader035.vdocuments.site/reader035/viewer/2022070323/56649e245503460f94b12012/html5/thumbnails/15.jpg)
(Ⅱ) Anti-tuberculosis therapy
Principle : Early , Complete
Intensificationtreatment
INH+RFP (早、中期)INH+RFP+SMINH+RFP+SM+PZA
3~4M
INH 15~25mg/kg.d RFP 10~20mg/kg.dSM 15~20mg/kg.d PZA 20~30mg/kg.d
Ⅷ treatment
![Page 16: Tuberculosis Meningitis 10 April, 2009. Ⅰ Ⅰ overview TBM is the most serious type in children with tuberculosis TBM is an early primary complications](https://reader035.vdocuments.site/reader035/viewer/2022070323/56649e245503460f94b12012/html5/thumbnails/16.jpg)
Consolidation treatment INH+RFP
course of treatment≥12Mor when CSF normal, continue treatment 6M
(Ⅱ) Anti-tuberculosis therapy
![Page 17: Tuberculosis Meningitis 10 April, 2009. Ⅰ Ⅰ overview TBM is the most serious type in children with tuberculosis TBM is an early primary complications](https://reader035.vdocuments.site/reader035/viewer/2022070323/56649e245503460f94b12012/html5/thumbnails/17.jpg)
(Ⅲ) decrease intracranial hypertension
CSF secretion : lateral ventricles choroid (占 70% ) Ependyma 、 encephalon ----TBM , Inflammatory stimulation, secretion
absorption : arachnoid granulations ---- TBM , absorb disturbance
circulation : ---- TBM, inflammatory in base of skull, pathway blocked
↑
Ⅷ treatment
![Page 18: Tuberculosis Meningitis 10 April, 2009. Ⅰ Ⅰ overview TBM is the most serious type in children with tuberculosis TBM is an early primary complications](https://reader035.vdocuments.site/reader035/viewer/2022070323/56649e245503460f94b12012/html5/thumbnails/18.jpg)
![Page 19: Tuberculosis Meningitis 10 April, 2009. Ⅰ Ⅰ overview TBM is the most serious type in children with tuberculosis TBM is an early primary complications](https://reader035.vdocuments.site/reader035/viewer/2022070323/56649e245503460f94b12012/html5/thumbnails/19.jpg)
(Ⅲ) decrease intracranial hypertension
1 、 dehydrant
20%mannitol : 0.5~1.0(2.0)g/kg. 次 iv q4h~q6h
2 、 adrenocortical hormone Dx 0.2~0.4mg/kg.d
3 、 lateral ventricular puncture 4 、 lumbar puncture decompression, intrathecal injectio
ns :
INH 、 Dx
5 、 Surgery :
Ventriculoperitoneal shunt or external drainage
![Page 20: Tuberculosis Meningitis 10 April, 2009. Ⅰ Ⅰ overview TBM is the most serious type in children with tuberculosis TBM is an early primary complications](https://reader035.vdocuments.site/reader035/viewer/2022070323/56649e245503460f94b12012/html5/thumbnails/20.jpg)
(Ⅳ) adrenocortical hormone therapy
Dx 0.2~0.4mg/kg.d Prednison 1~2mg/kg.d ( 4 weeks after decreasing , course : 8~12 weeks )
(Ⅴ) others 1 、 Control convulsions 、 Antipyretic 2 、 Water-Electrolyte Balance disturbances Hyponatremia ( dilutional, Cerebral ) Hypokalemia(Ⅵ) follow observation at least 3 ~ 5years
![Page 21: Tuberculosis Meningitis 10 April, 2009. Ⅰ Ⅰ overview TBM is the most serious type in children with tuberculosis TBM is an early primary complications](https://reader035.vdocuments.site/reader035/viewer/2022070323/56649e245503460f94b12012/html5/thumbnails/21.jpg)
criterion of curecriterion of cure
Symptoms disappearedSymptoms disappeared
CSF normalCSF normal
No recurrenceNo recurrence
((2 years After the end of Treatment)2 years After the end of Treatment)
![Page 22: Tuberculosis Meningitis 10 April, 2009. Ⅰ Ⅰ overview TBM is the most serious type in children with tuberculosis TBM is an early primary complications](https://reader035.vdocuments.site/reader035/viewer/2022070323/56649e245503460f94b12012/html5/thumbnails/22.jpg)
Ⅸ Ⅸ Prognosis (Relevant factors)
ageTime of therapy--- early or lateThe degree of brain damageTherapeutic method--- correct ?Tubercle bacillus--- resistance ?