1/74. diagnosis and treatment of complicated tubercular meningitis.A 41-year-old woman was seen in no acute distress with an infected ventriculoperitoneal shunt. She underwent several revisions of the shunt but was readmitted to the hospital with nausea, vomiting, and neurologic sequelae. Results of spinal fluid analysis were white blood cells 68/mm3 (25% neutrophils), glucose less than 20 mg/dl, and protein 513 mg/dl. cerebrospinal fluid, aerobic and anaerobic, and blood cultures were negative. Three weeks later the patient suffered a seizure and was prescribed antitubercular agents for a presumed diagnosis of tubercular meningitis. One week later, chest wound culture from her first visit suggested mycobacterium tuberculosis, which was confirmed by dna probe; cerebrospinal fluid culture eventually grew the organism. The patient fared well once she received antituberculosis agents. The time between first contact and treatment in the hospital delayed therapy.- - - - - - - - - - ranking = 1keywords = spinal (Clic here for more details about this article) |
2/74. Multidrug-resistant tuberculosis meningitis: clinical problems and concentrations of second-line antituberculous medications.OBJECTIVE: [corrected] To describe a case of culture-proven multidrug-resistant tuberculous (MDR-TB) meningitis, in which the patient survived long enough for clinicians to adjust antituberculous therapy to second-line therapeutic agents. DESIGN: Case report. SETTING: Tertiary care hospital. PATIENT: Twenty-one-month-old girl with MDR-TB meningitis. INTERVENTIONS: Initial standard treatment failed. Subsequent treatment with second-line therapeutic agents including ciprofloxacin, cycloserine, ethambutol, ethionamide, and rifabutin were given for approximately two years. Concentrations of these drugs were measured in serum and cerebrospinal fluid in the presence and absence of meningeal inflammation. MAIN OUTCOME MEASURES/RESULTS: The patient survived for approximately two years after initiation of second-line anti-TB therapy. During this treatment, she developed a ventriculo-peritoneal shunt tunnel tract infection secondary to MDR-TB. CONCLUSIONS: All TB meningitis isolates for which the source case antibiotic susceptibility pattern is not known should be cultured and susceptibility tested using rapid broth techniques. Measurement and subsequent adjustment of therapeutic drug concentrations may optimize therapy with second-line anti-TB drugs in TB meningitis. Better pediatric formulations and pharmacokinetic data for second-line and anti-TB therapeutic agents are needed.- - - - - - - - - - ranking = 0.33333333333333keywords = spinal (Clic here for more details about this article) |
3/74. Tuberculous meningitis in a Filipino maid.Tuberculous meningitis, while not uncommon in taiwan, has not been reported among foreign workers. We report the first case of tuberculous meningitis in a 37-year-old Filipino maid in taiwan, who presented with headache, fever and vomiting. She had been well before this episode and the small screening films of the chest radiograph obtained on her arrival in taiwan 15 months previously, and every 6 months thereafter showed no evidence of tuberculosis. The suspicion of tuberculous meningitis was delayed until disturbance of consciousness manifested and a standard chest radiograph showed a diffuse miliary pattern in both lung fields. A cerebrospinal fluid sample that was sent for a polymerase chain reaction-based assay specific for mycobacterium tuberculosis showed a positive result. The patient recovered with sequelae of mildly incoherent speech and urinary incontinence after antituberculous medication and short-course steroid treatment. Clinicians should be aware of the possibility of tuberculous meningitis in foreign workers with complaints of fever and headache. Because high-quality chest radiographs are a prerequisite for early detection of pulmonary tuberculosis, we recommended that standard posterior-anterior chest radiographs should be obtained as part of the routine health examination for foreign workers.- - - - - - - - - - ranking = 0.33333333333333keywords = spinal (Clic here for more details about this article) |
4/74. Spinal subdural tuberculous abscess.OBJECTIVES: Spinal subdural abscess is rare and only 48 cases have been described to date. In this report, we present an additional spinal subdural tuberculous abscess. METHOD: Tuberculous meningitis was diagnosed with clinical and laboratory findings in a 45-year-old man. A spinal subdural abscess was demonstrated using MRI. Presence of the abscess was revealed by surgical intervention. The diagnosis was confirmed by pathological examination. RESULTS: The patient had been treated for tuberculous meningitis 2 years previously. The disease recurred when anti-tuberculous therapy was prematurely discontinued. During the second treatment, the patient also underwent a ventriculo-peritoneal shunt operation for hydrocephalus. dizziness and weakness of both legs developed after the postoperative period. Spinal MRI showed a spinal subdural abscess as a iso-intense mass with spinal cord in the T1 and T2 weighted images, ring like enhancement and compression on the spinal cord at T3-T4 level. The patient underwent surgery and the abscess was drained. CONCLUSION: Tuberculosis may cause a spinal subdural abscess and although it is a rare disorder, when encountered MRI is very useful in the diagnosis.- - - - - - - - - - ranking = 2keywords = spinal (Clic here for more details about this article) |
5/74. Tuberculous radiculomyelitis complicating tuberculous meningitis: case report and review.Tuberculous radiculomyelitis (TBRM) is a complication of tuberculous meningitis (TBM), which has been reported rarely in the modern medical literature. We describe a case of TBRM that developed in an human immunodeficiency virus (hiv)-infected patient, despite prompt antituberculous treatment. To our knowledge, this is the second case of TBRM reported in an hiv-infected patient. We also review 74 previously reported cases of TBRM. TBRM develops at various periods after TBM, even in adequately treated patients after sterilization of the cerebrospinal fluid (CSF). The most common symptoms are subacute paraparesis, radicular pain, bladder disturbance, and subsequent paralysis. CSF evaluation usually shows an active inflammatory response with a very high protein level. MRI and CT scan are critical for diagnosis, revealing loculation and obliteration of the subarachnoid space along with linear intradural enhancement. As in other forms of paradoxical reactions to antituberculous treatment, there is evidence that steroid treatment might have a beneficial effect.- - - - - - - - - - ranking = 0.33333333333333keywords = spinal (Clic here for more details about this article) |
6/74. Intradural extramedullary tuberculoma of the spinal cord: a case report.Intradural extramedullary (IDEM) tuberculoma of the spinal cord is uncommon entity and moreover, few reports have been documented on concurrent IDEM and intracranial tuberculomas. Authors report a case of IDEM spinal tuberculoma having intracranial lesion simultaneously. A 49-year-old woman suffered from paraparesis and urinary incontinence while being given medical treatment for tuberculous meningitis. magnetic resonance imaging (MRI) revealed an IDEM mass lesion between the T1 and T2 spinal levels, and multiple intracranial tuberculous granulomas. Surgical resection of the IDEM tuberculoma followed by anti-tuberculous medication resulted in good outcome.- - - - - - - - - - ranking = 2.3333333333333keywords = spinal (Clic here for more details about this article) |
7/74. Fluid-attenuated inversion-recovery imaging of cerebral infarction associated with tuberculous meningitis.A 12-month-old girl presented with fever and vomiting. cerebrospinal fluid (CSF) examination revealed an increase of mononuclear cells and mycobacterium tuberculosis. magnetic resonance imaging (MRI) taken two months after the onset showed cerebral infarction in the left basal ganglia, tuberculoma in the interpeduncular cistern and brain atrophy. The infarction was shown as central cystic lesions with surrounding hyperintensity in the fluid-attenuated inversion-recovery (FLAIR) image. The cystic lesions were not differentiated from surrounding lesions in T2 weighted image (T2WI) because both lesions were demonstrated as hyperintensity areas. The hyperintensity lesion shown in FLAIR image may indicate border zone encephalitis. The FLAIR image is more useful than T1 or T2WI to detect the extension of the infarcted area and circumscribed change.- - - - - - - - - - ranking = 0.33333333333333keywords = spinal (Clic here for more details about this article) |
8/74. syringomyelia--as a late complication of tuberculous meningitis.The aim of this paper is to demonstrate the unusual MR features of thoracic syringomyelia following TB meningitis and to discuss the neurosurgical aspect of the treatment of this rare entity. Four years after a TB meningitis episode, a 30 year-old female patient developed a progressive spastic paraparesis. MR studies revealed multiloculated syrinxes throughout the thoracic cord. She had a syringo-subarachnoid shunt with a silastic "T" tube inserted. On the first postoperative day, she showed a dramatic neurological improvement, but unfortunately her paraparesis progressed to the preoperative level within a month despite diminished size of the syrinxes on the control MRI examination. Two and a half years after the operation the patient complained of having a burning type of central pain, and further deterioration in neurological function. Thoracic spinal MRI examination demonstrated enlarged syringomyelic cavities. At the second operation syringo-peritoneal shunt insertion was performed via right T10-11 hemilaminectomy using a "T" tube. At present, 4 months after the second operation, the patient's neurological examination demonstrated decreased spasticity, and improved strength in the legs compared to the preoperative level. MRI is the first choice of investigation in detecting TB related myelopathy as it provides a greater detail of pathological changes within and around the spinal cord such as syrinx formation and arachnoiditis. The MR findings are also helpful in deciding the management and predicting the outcome. Presence of multifocal loculations and arachnoid adhesions is the likely cause of treatment failures and poor prognosis.- - - - - - - - - - ranking = 0.66666666666667keywords = spinal (Clic here for more details about this article) |
9/74. Familial outbreak of disseminated multidrug-resistant tuberculosis and meningitis.Rapidly progressive multidrug-resistant tuberculosis (MDR-TB) is well documented in human immunodeficiency virus (hiv) positive subjects, but it is not fully recognised in hiv-negative subjects in the familial environment. We report three cases of MDR-TB in three young hiv-negative subjects from the same family. All the patients showed signs of meningitis during the course of their disease, and in two cases a resistant strain of mycobacterium tuberculosis was isolated in cerebrospinal fluid. Two of the three subjects died from neurological complications; the other was successful treated utilising both systemic and intrathecal therapy for tuberculous meningitis. By a retrospective analysis of dna obtained from Lowenstein-Jensen cultures, the strains were confirmed as M. tuberculosis resistant to rifampicin and isoniazid, and were closely related in the two cases where specimens were available for analysis. The resistance was acquired in two patients initially infected with a susceptible strain; in the other patient, the resistance was present on the first sensitivity test for which results were available. This report demonstrates the high risk of fatality from MDR-TB for hiv-negative subjects in the absence of reliable early diagnostic and preventive tools. It also reinforces the concept that genetic susceptibility to M. tuberculosis may be an important factor in the clinical presentation and outcome of MDR-TB.- - - - - - - - - - ranking = 0.33333333333333keywords = spinal (Clic here for more details about this article) |
10/74. Tuberculous meningitis associated with urinary tract tuberculosis.The association of tuberculous meningitis (TBM) and urinary tract tuberculosis is very rare. Two cases of this condition are reported. Both presented with subacute to chronic meningitis with lymphocytic pleocytosis, elevation of protein content and depression of glucose level of cerebrospinal fluid. pyuria and hematuria were detected and Ziehl-Neelsen's stain was positive for acid fast bacilli (AFB). Urographic abnormalities were compatible with urinary tract tuberculosis. AFB smear of urine is the simplest method to detect urinary tract tuberculosis.- - - - - - - - - - ranking = 0.33333333333333keywords = spinal (Clic here for more details about this article) |
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