We’re moving on to
And so when you say
keep in mind that granted, it is bacterial.
However, I need you to keep this
separate from the other bacterial causes
that I’d walk you through
based on the age groups
Are you with me?
Remember that table that I gave you
where it was predisposing factors,
but it was age groups, right?
And I gave you specifically
You’ll notice that in
that second column,
that there is no tuberculosis there
because you’re keeping it separate.
If you do that for me clinically,
you’ll be in good shape.
Now, the onset here
will be insidious.
Your typical symptoms
that you would expect,
so on and so forth.
And here, it causes a?
Please focus on basilar meningitis.
In other words, secondary angiitis
could also be possible because of
Is that clear?
The most important point in
this slide, in this section,
is going to be that last statement of
where it’s affecting your meninges.
And what you’re finding here on your CT,
now granted, in your
particular point in education
that by looking at the CT, you
would need to have proper history
so that you would then identify
what you find in that arrow
as being the actual pathology.
They may result in hydrocephalus,
but for the most part,
whenever you have meningitis, at some
point in time, you’re going to scar.
You could scar the
Picture that for me.
Close your eyes.
Are you with me?
Arachnoid granulation, where are you?
Subarachnoid space and this will be the
drainage point of your cerebrospinal fluid.
What if you scar them?
If you scar them and if you’re not familiar
with the concept of hydrocephalus,
this will a communicating,
nonobstructive type of hydrocephalus.
What did I say?
Don’t worry. It’s to come.
And it’s nonobstructive.
Also an explanation that I’ll give
to you when the time is right.
Stroke: what happened here?
Remember, you could have blood vessels
that are affected, interesting.
And with stroke, what
does that mean to you?
It means that there is a lack of blood
supply to whatever part of the brain.
So if you know for a fact that
tuberculosis or tuberculous meningitis
could affect the basilar
part of your brain,
and you could then affect
adjacent and result in angiitis,
What does that mean to you?
It means inflammation of the innermost layer of the arteries,
which can lead to occlusion and decreased blood flow to the tissue or organ that the artery supplies.
Here, we're gonna evaluate the supraspinal fluid for tuberculosis or tuberculous meningitis.
Keep this separate from all the others because the findings here are going to be a little bit different.
Here, predominantly, your WBCs will be lymphocytes.
Where else would you find lymphocytes, perhaps?
Viruses. Interesting. So, you find tuberculosis being a mix between bacterial and viruses.
Do that for me? You'll be in good shape. In bacterial, what kind of WBC would you expect to find?
Good, neutrophil. RBCs, none. When did we see RBCs in supraspinal fluid?
Oh, yeah, encephalitis or maybe brain abscess,
meaning to say, parenchyma involvement.
Look at this, glucose. Concept. This is microbacteria.
There you go. So, what is it going to do with glucose?
Consume it. Interesting.
So, I told you, with tuberculous meningitis, it's a hybrid in terms of CFS findings
between your viruses, lymphocytes, bacterial with neutrophils.
Here in tuberculous, you find lymphocytes.
Bacterial, glucose, expect that to be decreased, as you see here.
In viruses, glucose will be relatively normal.
Protein, on the higher side, and that's pretty much you're seeing with any type of meningitis,
but particularly higher with bacterial, and here we have tuberculous. Are we clear?
So, in order for you to understand this slide,
I would recommend that you understand your findings for bacterial viral -- viral meningitis first,
then take a look at your CSF findings for tuberculous. let's continue.
Let's take a look at management of tuberculous meningitis.
This obviously keeps advancing but at this point, at least know the basics.
Ripe, R-I-P-E, and R referring to refampin, I, INH, P, pyrazinamide, E, ethambutol,
and of course, you know about INH in all its glory in terms of causing sideroblastic anemia. All right?
Maybe consider moxiflox or moxifloxacin, steroids,
obviously if you're talking about taking care of the inflammation,
and you wanna think about giving more or less,
a drainage, alright, so you have your ventriculostomy for hydrocephalus.
Always a possibility, isn't it?
Surgical decompression if required, for sure,
because of that increased intracranial pressure.
Management of tuberculous meningitis in greater detail, know it well. Know it well.