In this article, we will discuss the Clinical Features of Tubercular Meningitis. So, let’s get started.
Clinical Features
The diseases has an insidious onset, evolves slowly over a period of 1-2 weeks-a course longer than that of bacterial meningitis. The initial symptoms are vague till the symptoms of meningeal irritation develop. They include listlessness, apathy, irritability, anorexia, nausea, vomiting and abdominal pain. There may be low grade fever. In about 10-15% in children and 25% adults, there is no history of fever. Acute onset of illness can occur in 50% of children but uncommon in adults. When meningeal irritation sets in, then there will be headache, vomiting becomes severe and signs of meningitis (neck rigidity, Kernig’s sign)appear. Even meningeal signs may develop late in the disease or even may not appear. The disease if untreated passes through three clinical stages:
Stage I (early disease): Patients presenting purely with meningitis with no disturbance in consciousness and without any neurological signs.
Stage II (moderate disease): Patients
have signs of meningitis plus consciousness is disturbed and focal neurological signs are apparent. The focal neurological signs include; hemiparesis, cranial nerve palsies (II, III, IV, VI, VII, VIII) and involuntary movements. Raised intracranial pressure may occur secondary to hydrocephalus (hypertensive hydrocephalus). In infants, there is bulging of fontanellae and the enlargement of head; while in adults papilloedema develops.
Stage III (advanced disease): The patient is deeply comatosed with signs of brainstem dysfunction, i.e. decorticate and decerebrate, rigidity, fixed dilated pupils, Cheyne-Stokes respiration with slow pulse rate or bradycardia.
Other modes of presentation of TBM include: acute meningitis, behavioural and intellectual changes, convulsions, visual failure due to (optochias-matic arachnoiditis), isolated cranial nerve palsy, stroke and raised intracranial pressure.
Atypical or modified clinical picture occurs in vaccinated children. Clinical manifestations of TBM in HIV-infected individuals are same as for TBM otherwise, though picture develops
more rapidly. Involuntary movements
(fine resting tremors, dystonic posturing of limbs and choreiform movements) are common in children and usually subside after 4-6 weeks. Epileptic seizures may be present at any stage, more common in children than adults.