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 obliteration of the endartery
to that particular tissue or organ.
This time, I have—
The end organ is your brain.
You got a stroke.
Here, we’re going to evaluate
the cerebrospinal fluid
for tuberculosis or
Keep this separate from all
the others because the
findings here are going to
be a little bit different.
Here, predominantly, your
WBC would be lymphocytes.
When else would you find
So you’ll 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?
When do we see RBCs in
Oh yeah, encephalitis
or maybe brain abscesses.
Meaning to say parenchyma involvement.
Look at this.
This is mycobacteria.
There you go.
So what is it going
to do with glucose?
So I told you with
it’s a hybrid in terms
of CSF findings between
your viruses, lymphocytes,
bacterial with neutrophils.
Here, with tuberculosis,
you’d find lymphocytes.
Bacterial, glucose, you’d 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 what you see
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 and
viral meningitis first,
then take a look at your CSF
findings for tuberculous.
Let’s take a look at management
of your tuberculous meningitis.
This obviously keeps advancing, but at
this point, at least know the basics.
and R referring to rifampin.
And of course, you know
about INH in all its glory
in terms of causing
sideroblastic anemia, right?
Maybe consider moxifloxacin.
Obviously if you’re talking about
taking care of the inflammation.
And you want to think about giving
more or less a drainage, right?
So you have your ventriculostomy
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.