BACKGROUND AND PURPOSE: Tuberculous meningitis (tbm), although comparatively rare, remains a serious clinical problem. MATERIAL AND METHODS: We have analyzed medical records of patients with tbm diagnosis hospitalized in our Department in the years 1995-2002. RESULTS: During that period 11 cases of tbm were diagnosed in the Department. Family contact with a person with diagnosed tuberculosis was revealed in 2 of them, previously treated pulmonary tuberculosis in 2 and active tuberculosis outside cns was diagnosed in 4. On admission 9 of the patients were unconscious. Neurologic abnormalities were present in all 11 patients, most commonly they were pathologic reflexes and cranial nerve abnormalities. Cerebrospinal fluid (csf) showed abnormalities in all patients, however, with a high variability of its parameters (cytosis: 12-4400 cells per microliters, protein concentration 52-482 mg/dL, low glucose concentration in 2 patients). CT scan revealed cns abnormalities (most typically hypodense foci and/or ventricular enlargement) in 5 patients. Microbiologic confirmation (M. tuberculosis growth from csf) was obtained in only 1 patient, despite intensive diagnostic efforts. The mean time from admission to proper diagnosis and start of antituberculous treatment was 9.9 days. Treatment effects were favorable (healing without serious neurologic sequelae) in 7 patients, permanent sequelae were observed in 3 and one patient died while in hospital. CONCLUSIONS: Our data confirm the presence of serious difficulties in the diagnosis and treatment of tbm. A prompt diagnosis and quick start of empirical treatment remain the most important means of reducing the mortality and frequency of permanent sequelae associated with this form of meningitis.
BACKGROUND AND PURPOSE:Tuberculous meningitis (tbm), although comparatively rare, remains a serious clinical problem. MATERIAL AND METHODS: We have analyzed medical records of patients with tbm diagnosis hospitalized in our Department in the years 1995-2002. RESULTS: During that period 11 cases of tbm were diagnosed in the Department. Family contact with a person with diagnosed tuberculosis was revealed in 2 of them, previously treated pulmonary tuberculosis in 2 and active tuberculosis outside cns was diagnosed in 4. On admission 9 of the patients were unconscious. Neurologic abnormalities were present in all 11 patients, most commonly they were pathologic reflexes and cranial nerve abnormalities. Cerebrospinal fluid (csf) showed abnormalities in all patients, however, with a high variability of its parameters (cytosis: 12-4400 cells per microliters, protein concentration 52-482 mg/dL, low glucose concentration in 2 patients). CT scan revealed cns abnormalities (most typically hypodense foci and/or ventricular enlargement) in 5 patients. Microbiologic confirmation (M. tuberculosis growth from csf) was obtained in only 1 patient, despite intensive diagnostic efforts. The mean time from admission to proper diagnosis and start of antituberculous treatment was 9.9 days. Treatment effects were favorable (healing without serious neurologic sequelae) in 7 patients, permanent sequelae were observed in 3 and one patient died while in hospital. CONCLUSIONS: Our data confirm the presence of serious difficulties in the diagnosis and treatment of tbm. A prompt diagnosis and quick start of empirical treatment remain the most important means of reducing the mortality and frequency of permanent sequelae associated with this form of meningitis.