Tuberculosis of the brain: symptoms, varieties, forms and methods of treatment. Symptoms and treatment of tuberculous meningitis Diagnosis and treatment

Like other varieties of the disease, these types of tuberculosis are caused by a tubercle bacillus that has entered the body in one way or another. Tuberculous mycobacteria were first identified from cerebrospinal samples in 1893.

Morphology and pathogenesis

Tuberculosis of the substance of the brain and nervous system has three ways of occurrence and spread:

Mycobacterium tuberculosis spreads throughout the body from sites of infection that may be in the lungs, lymph nodes, or other areas outside the lungs.

At the first stage, tuberculous meningitis develops in the hematogenous way, eventually breaking through the blood-brain barrier. As a result, infection of the vascular plexuses occurs. Further development disease occurs in the cerebral cerebrospinal fluid. Getting into the liquid spinal cord, tuberculous mycobacteria are deposited on the brain base, affecting the soft membrane and gradually destroying it.

As a result of inflammation, a specific exudate is formed. It accumulates in the area where the intersection of the optic nerves is located on the surface of the cerebellum, where the cisterns are localized.
In addition to the visual bundles, the inflammatory discharge can accumulate on the bulges of the brain, in its temporal lobes, as well as in the fronto-parietal.
Exudate can penetrate into the subarachnoid space and cerebral ventricles.
The soft shell of the brain during the pathological process is often saturated with serous-fibrinous contents, causing tissue necrosis.
The vascular plexuses and the membrane itself have an edematous appearance, with an abundance of hemorrhages.
In addition, miliary bulges are visible on the tissues of the shell.

Chronic and subacute course of meningitis of tuberculous genesis is characterized by the formation of granulomas in the tissues, in the center of which caseous necrosis is observed. Granulomas are visible not only in the tissues themselves, but also on the walls of blood vessels, this phenomenon may be accompanied by thrombosis. Damage to blood vessels most likely leads to swelling of certain areas of brain tissue and their softening. Since in the background is happening and inflammatory process, it can also attack the medulla, causing encephalitis.

Even if tuberculous meningitis is successfully transferred and the patient recovers, adhesions are likely to remain in the spinal cord, brain, and subarachnoid region. In their zones blood vessels are damaged, this leads to impaired circulation of blood and cerebrospinal cerebrospinal fluid, often with adverse consequences.

Symptoms

Signs of brain tuberculosis are usually divided into several groups, according to the time of manifestation:

symptoms of the prodromal period preceding the main symptoms. The period itself can last from 3 days to a month;
symptoms of irritation of the cranial nerves and soft membranes of the brain;
symptoms of brain damage.

The main symptoms at this stage are associated with poisoning of the body by the products of the activity of mycobacteria:

headaches, migraines;
lethargy;
weakness;
high level of fatigue, poor endurance;
general ailments;
poor performance;
poor appetite or its complete absence;
sweating;
nightmares, poor and disturbing sleep;
anxiety and irritability;
inhibition of thinking and actions;
apathy;
from time to time - an increase in temperature to subfebrile values.

At the end of the prodromal period, the time comes for the manifestation of symptoms of pathologies of the cranial nerves and the lining of the brain.

The following characteristic syndromes are distinguished for this period:

meningeal;
general infectious;
damage to the cerebrospinal fluid;
lesions of the spinal roots and fibers cranial nerves.

vomiting and nausea;
headache;
hyperesthesia;
neck muscle tension;
a specific posture of the body and characteristic phenomena: zygomatic symptom of Bekhterev and others.

Headache can be felt both “everywhere” and in certain areas (mainly in the frontal and occipital zones, this is due to the effect of inflammation on certain cranial nerves. The pain is often accompanied by vomiting, which does not lead to relief, while it occurs regardless of whether the patient has taken food. The vomiting effect is also caused by irritation of the nerve endings and the corresponding center.

For meningeal syndrome, the so-called chicken position is very characteristic - the patient lies with his head thrown back and his torso stretched out, his stomach is drawn in. The legs are bent and pressed to the stomach. The posture is caused by irritation of the nerves and the contraction of certain muscle groups stimulated by them.

General infectious syndrome - as the name implies, shows a picture of infection. The temperature is elevated and can range from subfebrile to very high. An increase in temperature may begin before the onset of a headache or occur simultaneously.

The change in cerebrospinal fluid is determined by samples. The liquid taken for analysis has an opalescent or transparent appearance; high blood pressure and can flow. The liquid contains a high content of protein and lymphocytes, and the mass fraction of glucose, on the contrary, is reduced.

This phenomenon is characterized by external symptoms, depending on which nerves were affected:

strabismus may develop;
partial or complete paralysis of facial muscles, tongue;
dilated pupils and other manifestations.
inflammation of the retina and posterior choroid may develop.

At the third stage, brain tissue is directly affected. Symptoms of this are deterioration or complete loss of functions for which the affected areas were responsible. These phenomena develop as a result of pathological processes of the vessels of the brain, as a result of which their lumen closes completely. Ischemia and softening of brain tissues develop in the affected area with the loss of their functions.

Diagnosis and treatment

The symptoms of tuberculosis mycobacteria in the brain and central nervous system are similar to those in meningitis of a different origin (caused by meningococci, viruses, staphylococci). Their main difference from each other is the different composition of the fluid taken during the puncture of the spinal cord. Therefore, to determine tuberculosis as the cause of the lesion, a differential diagnosis is carried out, which is necessary to exclude a non-tuberculous infection and prescribe the correct treatment.

For effective treatment patients with tuberculous meningitis must be placed in hospitals specially equipped for this, keeping at home is categorically unacceptable! The main drug for the treatment of any form of tuberculosis is Isoniazid. It can be prescribed in the form of tablets, if the patient is unconscious, then in the form of injections into the muscles or intravenous administration. It is Isoniazid that is considered the basic treatment for tuberculosis. The active substance passes the blood-brain barrier well, accumulates in the cerebrospinal fluid, quickly reaching an effective concentration.

In addition to Isoniazid, auxiliary drugs are also prescribed:

For unconscious patients, as well as for those whose condition is getting worse, a puncture is done daily, and streptomycin calcium chloride is also injected daily into the subarachnoid space, doing this for up to 10 days.

Patients require careful and constant care. For up to 3 months, strict bed rest is prescribed, and inpatient treatment can last more than six months. After the patient is discharged from the hospital, treatment does not stop; for a complete recovery, a person is prescribed sanatorium-resort treatment, for which there are special sanatoriums. Before the patient starts to get up, it is supposed to conduct physical therapy exercises with him right in bed.

During treatment, doctors may encounter complications, one of the most severe among them is the likelihood of hydrocephalus in a patient. Among other complications, disorders of motor activity, a decrease in the level of hearing, vision, and in some cases, the patient's intelligence is reduced.

In general, timely treatment of tuberculosis of the brain and central nervous system has a favorable prognosis. To date, complete recovery can be achieved in large numbers cases. In many ways, this is the merit of modern anti-tuberculosis drugs. Until a certain point, doctors tried to use conventional antibacterial agents and, unfortunately, the patients were doomed as the drugs proved ineffective. But today, the means developed by medicine provide healing for the majority of patients with tuberculosis, including those with lesions of the brain, spinal cord and central nervous system.

How tuberculosis of the brain manifests itself and is it contagious

Once in the human body, Mycobacterium tuberculosis can affect not only the lungs. One of the most dangerous manifestations of the disease is brain tuberculosis. As a rule, this is a secondary manifestation of the disease, infection of the meninges occurs from foci of tuberculosis that already exist in the body. The treatment of such a disease is fraught with great difficulties and takes a long time, but despite this it does not always lead to a complete recovery; the disease is often accompanied by serious complications. A decisive factor for a favorable outcome of the disease is timely and correct treatment.

Causes of the disease, forms of the disease

Tuberculosis is a serious and dangerous disease, which, despite all the preventive measures taken, remains very common. And although it is believed that this disease threatens only people of low social status, statistics say otherwise. Regardless of the standard of living, age and field of activity, everyone is at risk of contracting tuberculosis. After all, patients often open form of tuberculosis are not aware of their diagnosis and continue to remain in society, actively spreading the infectious agent - Koch's bacillus - around them.

The reason for the development of tuberculous lesions of the brain is the entry of Mycobacterium tuberculosis from the lesion located in the body (most often in the lungs) into the blood and penetration into the brain.

Infection of the brain with Koch's wand can occur in three ways:

Hematogenous (through the blood);

Lymphogenous (through the lymph);

Mycobacterium tuberculosis, getting into the blood, first infects the spinal cord, and then with the flow of cerebrospinal fluid (cerebrospinal fluid) penetrates to the membrane of the brain.

The spread of infection is very fast, and it is extremely difficult to resist it.

Tuberculosis of the brain manifests itself in two forms:

Tuberculous meningitis - mycobacteria act in the meninges and destroy them. Often the progression of tuberculosis of the meninges is accompanied by damage to other organs.
Solitary tuberculoma - characterized by a localized focus of tuberculous inflammation in the cerebellum or brain stem. As it grows, tuberculoma generates purulent processes and leads to an abscess. Tuberculous spondylitis is a lesion of the central nervous system.

In addition, brain tuberculosis is classified depending on the area of the lesion, its forms are distinguished:

Basal - damage to parts of the brain occurs at the base of the skull.
Convexital - convex surfaces of the brain suffer; this form is characterized by impaired consciousness.
Meningoencephalitis - inflammation of the brain in acute miliary tuberculosis; severe form of the disease, often ends lethal outcome.
Meningoencephalomyelitis is a simultaneous inflammation of the brain and spinal cord.

As a result of destructive processes on the membranes of the brain, the walls of blood vessels thicken, as a result of which blood circulation is disturbed, hypoxia (lack of oxygen) occurs, which gives rise to ischemic disease, brain tissue softens.

Most often, the development of brain tuberculosis occurs in people with a weakened immune system, patients with AIDS and HIV. Knowing the first signs and symptoms of this disease, a person is more likely to seek help from a phthisiatrician in time and receive the necessary treatment, thereby minimizing the risk of complications.

Symptoms

Depending on the form of the disease, its stage and the localization of the lesions, the symptoms of the disease can manifest themselves in different ways:

In the prodromal period - headaches of a short nature (dominus) that occur at a certain time of the day. With the progression of the disease, the pain becomes more and more prolonged, eventually becoming permanent. Sleep is disturbed, the person becomes nervous, irritable. There is a general malaise, increased fatigue, decreased concentration and performance. The lymph nodes become inflamed and painful. This period can last up to 2 months.
In the period of irritation - weakness, loss of strength, subfebrile temperature 37.0-37.5 0 C. Headaches intensify, bright light and harsh sounds cause severe discomfort. From the side gastrointestinal tract nausea and vomiting, lack of appetite are shown. This stage is accompanied by a sharp weight loss up to anorexia. Vision problems may occur - decreased sharpness, strabismus, distorted perception of colors.
The terminal period - occurs when the course of the disease is neglected without the necessary treatment. Characterized high temperature, most often there are signs of central paralysis, the patient in this period is unconscious. At this stage, achieve complete cure practically impossible, in addition, the probability of a lethal outcome is high. If a person can be saved, the accompanying complications will not allow him to return to a full life.

Solitary tuberculoma is characterized by nausea and vomiting, the temperature can rise to 39.0 0 C.

It is noted that such a manifestation of brain tuberculosis is more common in children and can provoke the development of hydrocephalus. An increase in temperature is accompanied by convulsions, progressing to paralysis. It is assumed that the child can adopt tuberculosis at the genetic level.

In general, in children with brain tuberculosis, the symptoms of the disease appear brightly and progress rapidly. Against the background of constantly rising temperature, the child has weakness, various manifestations of visual disturbances and impaired motor activity are possible.

When diagnosing, the doctor pays special attention to the identification of meningeal syndrome, which most likely indicates a tuberculous brain lesion. characteristic feature of this syndrome - a special posture of the patient, when the head is thrown back, the stomach is drawn in. Any attempts to change the position give a severe headache. This happens due to the stiffness of the occipital muscles. There are also failures in breathing, pressure surges, an increase in body temperature to critical levels.

Diagnostics

Since the symptoms of tuberculosis of the meninges are similar to the manifestations of other infectious lesions of the body, for an accurate diagnosis, the doctor must conduct a comprehensive examination.

Diagnosis is also difficult by the fact that often the patient himself does not see the first signs of the disease and is in no hurry to associate them with tuberculosis, since this form of the disease usually manifests itself against the background of an already existing infectious disease - SARS or influenza, which are accompanied by similar symptoms.

the study of biomaterials (blood, urine, feces, sputum) for the presence of Koch's bacillus, including the PCR method (polymerase chain reaction);
x-ray, computed tomography, MRI diagnostics will help to identify foci of infection and assess the degree of damage to the body, and with the help of a magnetic resonance tomograph, a specialist has the opportunity to obtain a photo not only of the surface membranes of the brain, but also of its inner layers;
puncture of the spinal cord - is crucial in establishing the diagnosis. A number of indicators of this sample are evaluated, emphasizing Special attention at the level of glucose: the more serious the stage of the disease, the lower this indicator will be.

In addition to the above studies, special attention is paid to the study of the anamnesis, the patient's predisposition to infectious diseases, and the presence of contacts with patients with tuberculosis.

Treatment

Comprehensive treatment of tuberculosis brain damage is carried out exclusively in a hospital and takes quite a long time. Firstly, a person at this time is contagious to others, and secondly, due to the severity of the disease, the patient must be constantly under the supervision of doctors.

The patient is prescribed complex drug therapy:

A complex of anti-tuberculosis drugs, the duration of which is at least six months. This includes Isoniazid, Pyrazinamide, Rifampicin, Ethambutol - these are drugs of increased anti-tuberculosis efficacy.
Analgesics - for relief pain patient, migraine relief.
Antipyretics - the disease is accompanied by an increase in body temperature.
Dehydration and detoxification drugs - are prescribed by a neurologist.
Vitamins C, group B, glutamic acid.

In severe form of the course of the disease can be assigned hormonal preparations, as well as symptomatic treatment aimed at restoring the functions of the optic nerve, paralyzed muscles and other consequences of the disease.

Medicines are available in different forms, which allows them to be taken both orally (in the form of tablets) and bypassing the gastrointestinal tract in cases where the patient is unconscious.

If a drug treatment is ineffective, the expediency of surgical intervention is considered. Basically, surgical care is resorted to with solitary tuberculoma, removing the focus of tuberculous inflammation.

After the hospital, patients are shown restorative rehabilitation in an anti-tuberculosis sanatorium, the program of which includes physiotherapy exercises and physiotherapy.

In addition, people who have had brain tuberculosis need to undergo a course of maintenance therapy several times a year, aimed at preventing possible relapses of the disease.

For several years after the cure, the patient will be registered in a tuberculosis dispensary. This measure is necessary for the systematic monitoring of the state of the body in order to prevent re-infection and the development of complications.

Complications and consequences

If, for some reason, timely diagnosis of tuberculosis of the brain and its adequate treatment is not carried out, the risk of severe complications increases.

There is a high probability of developing the following pathologies:

development of hydrocephalus (dropsy of the brain);
epilepsy;
loss of vision up to complete blindness;
hearing loss;
violation of motor activity - a person can remain paralyzed for life;
various kinds mental disorders and malfunctions of the central nervous system;
relapses of the disease.

If there is no treatment at all, irreversible consequences develop in the body, and an adult dies after 3-4 weeks from the onset of infection.

In the event of complications, it is almost impossible to completely restore all the functions of the body, and the chances of returning a person to a full life are negligible.

However, with the current level of development of medicine, in general, the prognosis for the treatment of tuberculous brain lesions is quite favorable. With timely access to a doctor and correct treatment, it is possible to avoid complications and achieve complete healing of the patient.

Prevention

And people who have had this serious illness, in order to avoid possible relapses, should carefully monitor their health, if possible, exclude the impact of negative factors, and lead a healthy lifestyle.

Rejection bad habits, regular physical exercise, proper nutrition, enriched with vitamins and microelements, will strengthen the protective functions of the body and reduce the risk of relapses to a minimum. Recommended food rich in animal proteins and fats, as well as with high content iodine.

life after tuberculosis

Depending on how effective the treatment turned out to be, and whether the person managed to fully recover after the illness, the quality of his life and the ability to continue working depend.

The field of activity will have to be changed if the professional activity before the illness was related to:

production that provides harmful effect on the body;

With increased risk injury.

To maintain health and prevent recurrence of the disease, a person needs the most comfortable conditions for life and work.

If the disease was accompanied by complications, then the issue of a person’s ability to work will be decided individually in each case. After all, the consequences of such complications can be varying degrees severity, sometimes a person remains disabled for life.

Tuberculosis of the meninges

Tuberculosis of the meninges is divided into:

tuberculous meningitis, which is often accompanied by damage to the substance of the brain and spinal cord (meningoencephalitis, meningoencephalomyelitis);
tuberculoma of the brain;
spinal cord injury in tuberculous spondylitis.

Tuberculosis of the meninges in most cases develops as a result of hematogenous dissemination of Mycobacterium tuberculosis from the primary focus in the lungs, lymph nodes or kidneys. In more than 50% of patients, damage to the meninges is the first clinical manifestation of tuberculosis. In 1/3 of infected meninges tuberculosis occurs against the background of disseminated pulmonary tuberculosis, which is detected simultaneously with the lesion of the meninges. The significance of fibrous-cavernous pulmonary tuberculosis as a source of tuberculosis of the meninges has become significantly lower.

Morphologically, the process is characterized by acute serous-fibrinous inflammation of the meninges. In the subarachnoid (subarachnoid) space of the brain and spinal cord, a grayish-yellow effusion is found, in the pia mater and ependyma - miliary and larger tuberculous granulomas, incl. with signs of caseous necrosis. In the foci of tuberculous inflammation, lymphocytes predominate. The ventricles of the brain dilate and fill with cloudy fluid (hydrocephalus). The substance of the brain and spinal cord is often involved in the inflammatory process. In 85-90% of cases, tuberculosis attacks the meninges and the brain at its base, at the level of the interpeduncular cistern (basal meningoencephalitis).

Basal meningoencephalitis develops in most cases gradually. Often there is a prodromal period, which is accompanied by:

subfebrile body temperature;
general malaise and weakness;
decreased performance and appetite;
sleep disturbance;
irritability.

The prodromal period in tuberculosis of the meninges is replaced by a detailed picture of the disease. However, acute development of the disease is possible, especially in young children. Constant symptom is a fever (subfebrile, relapsing, hectic or irregular), which often precedes the onset of a headache or occurs simultaneously with it. Headache has a different intensity and gradually increases. Some patients also report pain in the chest or lumbar regions spine, indicating damage to the membranes and roots of the spinal cord. On the 5th-8th day of illness, vomiting appears, subsequently it becomes more intense. In the first days of the disease, meningeal symptoms are mild, the patient continues to walk, often even work. On the 5-7th day of illness, these symptoms become clear, their intensity increases.

There are mental disorders, various focal symptoms.

On the 1st week of illness, along with headache, increasing lethargy, apathy, and a decrease in motor activity are noted.

On the 2nd week of the disease, general hyperesthesia appears, apathy and partial hearing loss increase, delirious or oneiroid states develop. Memory for current events weakens, orientation in space and time is gradually lost.

Damage to the cranial nerves can be detected at the end of the 1st - beginning of the 2nd week of illness. The most characteristic paresis III, IV and VII cranial nerves. In connection with the defeat of the diencephalic region, symptoms such as bradycardia, red dermographism, Trousseau spots, and sleep disturbances are observed. Signs of congestive nipples of the optic nerves appear and grow. The development of paresis and paralysis is often preceded by paresthesia of the corresponding limbs.

At the 2nd week of the disease, violations of tendon reflexes and muscle tone, pathological reflexes of Babinsky, Rossolimo, Oppenheim, etc. appear. Severe paresis and paralysis of the limbs in patients who have not received specific therapy usually occur on the 3rd week. Aphasia with paralysis is observed in 25% of those infected. In most cases, along with paralysis, hyperkinesis occurs. Hemiparesis is observed much more often in young children and the elderly, sometimes in the first days of illness. AT individual cases they are associated with convulsions. At the end of the 2nd week of illness, the functions of the pelvic organs are disturbed. During the 3rd week, the condition of patients continues to deteriorate rapidly. Stunnedness progresses to precoma and then to coma. tendon and pupillary reflexes fade away, sometimes decerebrate rigidity develops.

Rarer varieties of the disease include diffuse and limited convexital tuberculous meningoencephalitis (lesion of the convexital, i.e. facing the cranial vault, surface of the brain) and tuberculous meningoencephalomyelitis (cerebrospinal form of tuberculous meningitis). Features of diffuse convexital meningoencephalitis are more acute than with basal meningoencephalitis, the onset ( headache and an increase in body temperature), a rapid loss of consciousness.

With limited convexital meningoencephalitis (the process is localized in the region of the central gyri of the brain) initial symptoms diseases are paresthesia, hemiparesis, aphasia, epileptic seizures against the backdrop of increasing fever and headache. With such localization, the disease can take a long course with remissions and exacerbations. After a while, basal meningoencephalitis joins.

Tuberculous meningoencephalomyelitis can be ascending and descending.

Ascending is manifested primarily by symptoms of meningoradiculoneuritis with dysfunction of the pelvic organs: meningeal symptoms join later (sometimes after a few weeks).

Descending is expressed by the rapid spread of the process from the base of the brain to the spinal cord and the predominance of symptoms of damage to the membranes and substance of the spinal cord in the clinical picture of the disease.

The diagnosis is established on the basis of the clinical picture, anamnesis data, including contact with a patient with tuberculosis, pulmonary tuberculosis, results laboratory research. It is important to detect Mycobacterium tuberculosis in the cerebrospinal fluid (using microscopic, cultural studies, biological samples) or the pathogen antigen.

Cerebrospinal fluid, as a rule, is transparent or opalescent, colorless (in case of damage to the membranes of the spinal cord with a block of cerebrospinal fluid, it is xanthochromic), its pressure is increased (more than 300-500 mm of water column). The content of total protein is increased to an average of 1-3, 3 g / l, with damage to the membranes of the spinal cord, it is 30-60 g / l or more.

Moderate pleocytosis is observed (average 100-500 cells per 1 μl), in most cases it is lymphocytic, less often mixed. In some cases, neutrophils predominate in the cerebrospinal fluid. The sugar content in the cerebrospinal fluid progressively decreases as the disease progresses. The amount of chlorides is reduced to 141-169 mmol/l. When the cerebrospinal fluid stands in a test tube for a day, a thin fibrinous film forms in it. Changes in the blood are mild.

Differential diagnosis in early dates tuberculosis of the meninges is carried out with influenza, typhoid fever; with the appearance of neurological symptoms - with viral, bacterial and fungal meningitis (meningoencephalitis), abscess and brain tumor.

Treatment of tuberculosis of the meninges

Treatment of patients with tuberculosis of the meninges is complex. Combinations of three to four anti-tuberculosis drugs are used. Isonicotinic acid hydrazide derivatives (isoniazid, ftivazid, metazid) are used, which penetrate the blood-brain barrier in bacteriostatic concentrations, rifampicin, ethambutol, streptomycin (intramuscularly) and pyrazinamide.

Duration antibiotic therapy must be at least 6 months from the date of sanitation of the perebrospinal fluid. With late diagnosis of tuberculous meningitis and a serious condition of the patient, the use of glucocorticosteroid hormones is indicated. Tuberculostatic therapy should be combined with the introduction of vitamins B1, B6, ascorbic and glutamic acids. Dehydration and detoxification therapy is also needed. With paresis and paralysis, after mitigation of the meningeal syndrome (after 3-4 weeks), prozerin is prescribed, massage and exercise therapy are indicated.

Patients with tuberculosis of the meninges in the acute period of the disease should be on strict bed rest for 1-2 months. Subsequently, as the general condition improves, the regime is expanded. Discharge from the hospital can be carried out after the disappearance clinical manifestations diseases and rehabilitation of cerebrospinal fluid, but not earlier than 6 months from the start of treatment. From the hospital, patients are sent to an anti-tuberculosis sanatorium.

The prognosis for early diagnosis of tuberculosis of the meninges and adequate treatment is often favorable - recovery occurs. At a late start specific treatment epilepsy, compensated hydrocephalus can develop, paresis persists, and death is possible. Severe hydrocephalus, blockage of the cerebrospinal fluid, cholesteatoma are rare.

Dispensary supervision.

Adults who have had tuberculosis of the meninges are observed by a phthisiatrician of an anti-tuberculosis dispensary for 2 years in subgroup A of group I of the dispensary registration in the presence of pulmonary tuberculosis or in subgroup A of group V in its absence.

In the future, they are registered for an average of 1 year in subgroups B and C of group V. Children are observed by a phthisiatrician for 1 year in subgroup A of group V, then 2 years in subgroup B of group V and the next 7 years in subgroup C of group V.

At residual effects on the part of the nervous system or eyes, observation and treatment by a neuropathologist, psychiatrist, ophthalmologist is also necessary. For 2-3 years after discharge from the hospital, three-month preventive courses of isoniazid in combination with ethambutol or pyrazinamide are carried out annually.

The question of the ability to work or disability of patients who have had tuberculosis of the meninges is decided by the VKK, individually, taking into account changes neurological status and profession of the patient. In most cases, patients return to their professional activity. Persons engaged in heavy physical labor before illness or working in hazardous industries need to be transferred to easier work. The issue of continuing education is decided individually. During the first year after inpatient treatment, increased mental stress and traumatic operations are not recommended.

Tuberculosis of the brain

Extrapulmonary tuberculosis is a fairly common phenomenon. With this pathological process, mycobacterium tuberculosis conducts its vital activity in the tissues of many human organs (tuberculosis of the eyes, bones, and gastrointestinal tract is known). When Koch's wand touches nervous system, then tuberculosis of the brain develops. According to medical statistics, tuberculosis of the brain currently accounts for about 3% of all tumors that affect the brain.

Tuberculosis of the brain: types

Doctors distinguish two main forms of cerebral tuberculosis:

Tuberculous meningitis is a specific inflammation of the meninges. Most often, such a disease occurs after suffering tuberculosis of some other localization or is combined with already existing tuberculosis of other organs.
Solitary tubercle - specific brain tumors. As a rule, tubercles consist of tuberculous tissue, where for some time a purulent decay forms with the formation of a tuberculous abscess. The size of tubercles ranges from grain to large chicken egg. The main places of localization of the pathological process are the brain stem and cerebellum.

Tuberculosis of the brain: symptoms

Symptoms and signs of the disease depend on the form of the disease.

With tuberculous meningitis, the symptoms will appear depending on the period of development of the disease.

The prodromal period is the average duration from 1 week to 2 months. At this time, there is a headache, nausea, vomiting, fever. Body temperature is most often subfebrile (37 - 37.5 0 C), urinary retention may be observed.
Irritation period - occurs 1-2 weeks after the termination of the previous period. The main symptoms are fever, headache is localized mainly in the frontal and occipital lobes, the abdomen is scaphoid, depression, lethargy. Gradually, photophobia and noise intolerance appear. Large red spots periodically appear on the face and chest. By the beginning of the second week of the period, characteristic meningeal symptoms are observed (stiff neck, Kerning and Brudzinsky symptoms). Quite often, there are disorders of the organs of vision - strabismus, poor focusing, paralysis of the eyelid.
The terminal period is 2-3 weeks of the disease. This period is characterized by lack of consciousness, paralysis, paresis, high temperature.

With solitary tuberculum, the symptoms will be as follows: with an increase intracranial pressure observed nausea, vomiting. For young children, an increase in the size of the skull is characteristic. The disease begins with the appearance of convulsions, paralysis gradually joins.

Tuberculosis of the brain: treatment

Treatment of cerebral tuberculosis is carried out in stationary conditions, chemotherapy (Streptomycin, Ftivazid) is indicated, with a solitary tuberculus, surgical intervention is performed, followed by removal of the tubercle. If left untreated, death occurs in 100% of cases.

Tuberculoma of the brain is a form of tuberculosis that affects the nervous system. In fact, it is a tumor that has clear boundaries. It develops in people with pulmonary tuberculosis, lymph nodes chest or other organs. The infection enters the brain through lymph or blood, continuously circulating in the body.

Most often, this form of tuberculoma affects children aged 5 to 10 years, and this formation is detected twice as often in male patients. At the same time, the symptoms of the disease are in many ways similar to those of a conventional brain tumor. But, of course, there are some differences.

Causes of the disease

As already mentioned, brain tuberculoma is provoked by tuberculosis, which has developed in some organ. Through lymph or blood dangerous infection enters the brain and begins to act destructively on some part of it. As the disease progresses and a tumor appears, symptoms begin to appear. True, in rare cases, brain tuberculoma can develop on its own, even if there is no source of infection in some other organ.

Although tuberculoma can develop in any part of the brain, it most often forms in the back of the brain.

Symptoms

Almost always, the disease manifests itself acutely, like a common infectious disease. The temperature comes first. It can reach 38ºС and higher. Along with a feverish state, pains in the head appear, nausea is felt, and vomiting may open. General weakness is often accompanied by unsteadiness when walking, cramps in the legs or arms. Gradually, the symptoms become more pronounced. Periodically, a state of relief occurs, after which the disease makes itself felt again.

So, the most common symptoms of brain tuberculoma can be considered the following manifestations:

Most often, the patient experiences general weakness. It manifests itself as rapid fatigue, fatigue. It is very difficult for a person to perform even simple and familiar work for himself.
Also, almost always the patient begins to sweat intensely. And this happens even when a person does not experience serious physical or psycho-emotional stress.
An increase in temperature occurs in about 70% of cases.
Still quite often there is unsteadiness when walking.
In about half of the cases, the patient suffers from nausea, headache (spread to the entire head), seizures. There may even be loss of consciousness, which is sometimes accompanied by convulsions.
A little less often (approximately 40% of all cases of morbidity) opens severe vomiting and there is a strange weakness in one half of the body.
Sometimes memory impairment is possible. A person begins to forget some facts and moments from life.

Symptoms of the disease may differ depending on which part of the brain tuberculoma has formed and at what stage of development it is. For example, if the cerebellum is affected, then motor disorders will appear, if the central gyrus - sensitivity disorders, convulsions. In the event that tuberculoma has formed in the frontal lobe of the brain, then serious disorders of coordination and psyche may occur.

The illness can last from several days to several months. If at first the patient's symptoms are pronounced, then gradually they subside and become fuzzy. A low temperature rise persists for a long time. As the disease develops, after 4-6 months, disturbances in the work of the nervous system are already seriously manifested. For example, children become lethargic, inhibited, they show all the symptoms of intoxication (poisoning) of the body.

Treatment

A number of studies help diagnose tuberculoma. Blood and cerebrospinal fluid are analyzed. A chest x-ray is also done, since it is often pulmonary tuberculosis that causes infection of the brain. You may also need an electroencephalography, which examines the activity of the brain, and an x-ray of the skull, which allows you to identify deposits of calcium salts in it. Doctors may prescribe magnetic resonance or CT scan with which you can study in detail each part of the brain.

If a brain tuberculoma has been identified and its exact location determined, then there can be only one treatment - an operation to remove the tumor. But for the result to be successful, the patient needs to take drugs as part of anti-tuberculosis therapy. Be sure to do repeated examinations to know how effective the treatment is.

If a earlier mortality as a result of the operation to remove brain tuberculoma reached 96%, today the situation is more encouraging - 75%. And all this thanks to the fact that it is possible to use more modern drugs against tuberculosis, which are much more effective than those that preceded them.

Prevention

There are a combination of factors that can trigger this disease: severe infections, poor living conditions, malnutrition, drug or alcohol use. Because of this, a person's immune forces are greatly reduced, as a result of which he can become ill with tuberculosis. Knowing this, one should try to avoid these provoking factors. You should also avoid contact with people with tuberculosis, and timely undergo preventive examinations with doctors.

Tuberculosis of the brain, also called pathology of nerve endings and meninges, is the most dangerous form diseases. He provokes the largest number complications and are the most difficult to treat. To understand the presented disease, it is necessary to study in more detail the factors of its formation, symptoms and other nuances.

The formation of tuberculous lesions of the brain is affected by activation and severe damage to the body by mycobacteria. Most often, the presented form of the disease occurs in people infected with HIV. Speaking in more detail about the methods of transmission of the disease, it should be noted that it can be hematogenous (that is, through blood or plasma), liquorogenic. In this case, mycobacterial components penetrate to the membranes of the brain through the cerebrospinal fluid.

In the formation of tuberculosis of the brain, the presented sequence of actions is noted, that is, negative agents first penetrate into the blood, while the body is extremely weakened. Further, a progressive infection of the body occurs, due to which the spinal cord and the brain region are affected.

This process develops extremely quickly, and therefore it is difficult to stop it.

In order to better understand the overall picture of the disease, it is necessary to take into account all the symptoms.

Symptoms of pathology

Tuberculosis of the brain is associated with special symptoms. Manifestations usually begin with headaches that progress gradually. At first, they appear only at certain times of the day and disappear after 20-30 minutes. After that, migraines begin to torment a person at night. With this algorithm, headaches gradually become permanent. It is necessary to note other symptoms, the assimilation of which is important for understanding the presence of tuberculosis:

general weakness and malaise, which appear before the onset of headaches;
increased fatigue and quickly appearing fatigue - even after minor physical effort;
aggravation of working capacity and inability to concentrate;
loss of appetite and a sharp decline body index.

Phthisiologists and neurologists draw attention to the fact that symptoms may be accompanied by sleep disturbance and a high degree of irritability. With a total lesion of the body, a constant subfebrile temperature is identified, that is, at least 37 degrees. This may be accompanied by a feverish or agitated state, which is quickly replaced by apathy or other similar manifestations.

The presented symptoms are dangerous because they are not characteristic of any particular disease, therefore, difficulties arise in the process of their identification or the patient does not pay attention to them. As a result, even more severe and aggravated symptoms are formed.

More about symptoms

Speaking about the manifestations of tuberculous lesions of the brain, it is necessary to note the rarest of them or the most specific ones. These include disorder visual functions, manifested not only in the aggravation of vision, but also in the distortion of vision, certain deviations. This may be a color perception disorder or a certain type of myalgia.

Symptoms may be accompanied by a disorder of consciousness, temporary or prolonged loss of memory. This leads to serious consequences, because it is not uncommon for a person with a tuberculous lesion of the meninges to get lost and cannot be found. It is almost impossible to avoid such a process and exclude the presented symptoms, because they indicate that the disease is at the last stage, which means that the recovery process will not be sufficiently effective. Talking about the symptoms, one should not forget about the specific classification of the presented disease, because tuberculosis of the meninges can be of 4 types.

Classification of the disease

The division into certain subspecies occurs depending on the area and location of the lesion. There are the following varieties:

basal, in which the inflammatory algorithm is located in the same area as the base of the brain and is identified by a combination of meningeal symptoms with manifestations of lesions of the cranial and cerebral nerves;
convexital, beginning acutely with headaches and forcibly increasing disturbances within the consciousness, while the symptomatology is accompanied by a psychomotor excitation and all kinds of disturbances of consciousness;
meningoencephalitis, to the standard symptoms of which they join and begin to dominate manifestations of local lesions in the nervous system;
meningoencephalomyelitis, the most common form of which is ascending and as part of its development there is a destabilization of the activity of the pelvic organs, after which signs of a meningeal nature are activated.

Speaking about the last variety of tuberculous lesions of the brain, it is necessary to note the descending type. In the process of its development, pathological changes are identified, which from the base of the brain begin to spread to the membranes and subarachnoid space. The presented forms of the disease in rare situations also apply to children in whom the disease is accompanied by much more pronounced manifestations.

Form in children

AT childhood submitted form pathological condition forms the least often, but it is characterized by the most rapidly developing signs. This is due to the instability child's body, lability of immunity and other important criteria. It should be noted that a child may develop a genetic predisposition to the described disease.

Symptoms in childhood debut immediately and with the most complicated manifestations. These include concentration disorder, visual defects that can appear simultaneously in several forms. The child is faced with constantly increased temperature indicators, which adversely affect his well-being.

A separate symptom should be considered muscle rigidity and problematic maintenance of tone. This seriously impairs and makes it impossible for the child to move or perform any elementary actions. In order to exclude the presented reactions or minimize them in the development of a brain disease, it is necessary to carry out a diagnostic examination of the body in time.

Diagnostic measures

For adults and children who have developed meningeal tuberculosis, diagnosis begins with a medical history. This is necessary to determine the predisposition to respiratory diseases and problems in the activity of the brain system. You should also pay attention to the following examinations:

tests for the presence of mycobacterial components in blood, urine, feces or sputum;
X-ray and ultrasound, with the help of which it is possible to establish the degree of damage to the body and the rate of spread of the presented process;
CT, MRI, PCR and other methods, if the diagnosis is in any doubt.

Diagnosis in the presented brain disease is necessary to prescribe a rehabilitation course, but it is no less necessary to determine its effectiveness. Phthisiologists pay attention to the fact that it is recommended to conduct an examination at each stage of therapy and after its completion. This is due to the fact that many patients develop complications after the treatment cycle is completed.

Fundamentals of treatment

The main condition for starting therapy is its implementation in a hospital setting. This will allow you to control the presented process throughout the recovery course. Isoniazid should be considered as the primary drug used in this process. It is used orally, and if the patient is unconscious with a brain disease, intravenous or intramuscular injection is possible.

In addition to the presented remedy, it is permissible to prescribe drugs such as rifampicin, ethambutol and streptomycin. Their use occurs when allergic reactions on the main component or it does not guarantee the expected effect. To reduce headaches and discomfort use analgesics and similar drugs that do not provoke addiction.

An important condition when prescribing treatment is that it must remain complex, because in this case it will make it possible to cope with a whole range of problems arising from tuberculosis of the brain.

More about treatment

If for a long period of time medicines are ineffective, resort to the implementation of surgical intervention. This is done only in extreme cases, that is, when the risk of complications is more significant than the likelihood of consequences after surgery. Its main goals are as follows:

getting rid of sputum and other negative components that “clog” the lung area;
preventing the subsequent penetration of mycobacterial components in the body and their spread up to the spinal cord;
probable correction of birth defects that minimize the effect of drugs.

In childhood, the implementation of surgical intervention is carried out most rarely. Phthisiologists pay attention to the fact that after the operation an additional recovery course will be required, which will improve the functioning of the body and help to cope with complications and consequences. this disease brain.

Complications and consequences

Speaking about the complications associated with tuberculous lesions of the brain, it is necessary to single out the formation of hydrocephalus, which is the most severe and practically untreatable condition. In addition, motor-functional disorders, aggravation of visual and auditory functions, reduction or distortion of mental abilities may occur. All this makes a person incapacitated and deprives him of the minimum functions that allow him to save 100% of his life.

A relatively optimistic prognosis is identified within the framework of the development of basal and convectal forms of tuberculosis pathology. With an early start of treatment and its correct management in patients with such forms, it will be possible to achieve an absolute cure. An equally important role in the presented process is given to preventive measures which are mandatory.

Preventive actions

Correct prophylaxis makes it possible to consolidate the success after therapy and exclude the possible formation of complications. Phthisiologists pay attention to the fact that a 100% cure for the presented form of the disease is achieved only with a long-term recovery - at least 24 months. However, prevention is necessary throughout the algorithm and the first condition is the exclusion of all bad habits.

We are talking about quitting smoking, drinking alcohol and drugs. It is equally important to observe physical activity: walking, daily morning exercises, hardening. In addition, prevention should be supplemented with fortification and strengthening of the body. For this purpose, they resort to a special diet, as well as use vitamin and natural complexes. The diet should include a significant amount of seasonal fruits and vegetables, natural proteins, fats and carbohydrates. A mandatory part of the menu should be sea fish and products containing iodine, as well as trace elements such as zinc, phosphorus, potassium.

Such a way of life must be preserved and maintained throughout its duration. Only with this approach, as well as the exclusion of contacts with infected persons, it will be possible to avoid a relapse of the disease or its transformation into other forms.

Given the high severity of a disease such as tuberculosis of the meninges, it is necessary to pay special attention to the diagnosis and subsequent treatment. This will allow you to start a quick recovery of the body, as well as eliminate the likelihood of complications. An integrated approach is the only true one in detecting the presented pathological condition.

Tuberculosis of the brain - infection that affects the membranes of the brain, the brain itself and the central nervous system. The pathogenic agent is Koch's bacillus and other tuberculosis mycobacteria.

Pathology can take two forms:

tuberculous meningitis;
solitary tuberculosis.

With tuberculous meningitis, the inflammatory process of any of the meninges progresses. Most often, this disease develops as a secondary or together with damage to the tissues of other organs.

A solitary tubercle is a focus of inflammation in the form of a neoplasm (tuberculoma) in the brain. After some time, tuberculoma passes into a purulent stage with the formation of an abscess. Basically, the pathology is localized in the cerebellum or tissues of the brain stem.

According to the pathways of spread, tuberculosis of the brain is divided into:

hematogenous;
lymphatic;
perineural.

According to the affected area, there are:

basal form;
convexital form;
meningoencephalitis;
meningoencephalomyelitis.

Symptoms and periods

The clinical picture of cerebral tuberculosis depends on which area of the organ has been affected, which brain centers are affected by the mechanical action of inflammation or tuberculosis of the brain, and also on the period (stage) of the disease.

Signs of tuberculosis of the brain will depend on the form.

At t uberculous meningitis There are three periods of illness:

prodrome
irritation period
terminal period.

signs of prodromal or initial stage tuberculous meningitis are:

periodic, occurring at the same time, increasing headache, migraine;
nausea;
fever;
a slight increase in temperature;
general malaise;
apathy;
lack of appetite;
decrease in vitality and performance.

These manifestations of the disease are due to the active vital activity of pathogenic mycobacteria, intoxication of the body by the products they secrete.

The prodormal period lasts from several days to 2 months.

The period of irritation occurs 7-14 days after the cessation of the initial. From a physiological point of view, it is characterized by irritation of the meninges and nerve endings.

Symptoms of the period of irritation:

headaches of a general and local nature (associated with the area of localization of tuberculosis lesions);
gag reflex, nausea;
hypersensitivity to external stimuli, photophobia;
hyperemia of the skin (large red spots on the chest and face);
temperature rise;
tension in the back of the head.

In the terminal period, the patient has symptoms caused by damage to certain brain centers:

there is a thickening of the walls of the vessels, which causes a narrowing of the lumen, and, as a result, insufficient supply of certain parts of the brain with oxygen;
development of muscle paresis, complete paralysis is possible;
disturbances in the work of the ophthalmic and auditory nerves;
violation of the function of the organs of vision (uneven dilation of the pupils with a lack of reaction to light, strabismus).

Changes in brain tissue also cause mental abnormalities. The patient may experience symptoms such as partial or complete loss of memory, disturbances in behavior, thinking and perception. It also happens that patients lose consciousness during this time.

If the disease has reached terminal stage, then it will no longer be possible to restore brain tissue and damaged brain centers. The patient most often remains disabled for life, and death is not uncommon.

For solitary tubercle typical symptoms are:

increase in intracranial pressure;
against the background of it, nausea, vomiting are possible.

In children in early age with this form of the disease, the size of the skull increases. With the development of tuberculoma in the brain, the appearance of convulsions, with time paralysis, is characteristic.

Diagnostics

Due to the similarity of symptoms with brain lesions of another origin, a thorough differentiated diagnosis is required. First, the patient's history is carefully studied, the causes of tuberculosis are clarified. Laboratory tests of blood, urine, sputum and other separated fluids are carried out to detect mycobacteria. In order to accurately identify brain damage with mycobacteria, a cerebrospinal fluid puncture is taken.

To establish the stage of the disease, the area and extent of the lesion, x-rays are taken and ultrasound examinations. To eliminate doubts about the diagnosis, if they arise for some reason, studies such as CT or MRI can be prescribed.

During treatment, diagnostics are also required to determine whether the therapy regimen is chosen correctly and to assess the dynamics of the disease. Analyzes and studies of the patient are carried out at each stage of treatment, as well as after its completion, to track the development of complications and dangerous consequences.

Treatment

Treatment of tuberculosis of the brain is carried out exclusively in a hospital under constant medical supervision. Today, the therapy of all forms of tuberculosis is based on the introduction of the drug Isoniazid. The patient can receive the medicine, both in the form of tablets, and intramuscular or intravenous injections.

The active substance of isoniazid accumulates quite quickly in the body and successfully fights the blood-brain barrier of the brain.

If the patient is in a coma, and with the negative dynamics of the disease, potassium chloride streptomycin is injected into the space between the meninges. If isoniazid therapy is not effective, or the patient develops an allergy to active substance, other drugs are used, most often it is Ethambutol or Rimfapicin.

Simultaneously with treatment aimed at eliminating the cause of the disease, the patient is prescribed symptomatic treatment. To reduce the intensity of headaches, analgesics that do not cause drug dependence are used.

In the first two or three months, the patient is shown strictly bed rest and complete rest. In the future, the doctor may prescribe physiotherapy and exercise therapy to shorten the recovery period.

Forecast and consequences

In the absence of treatment, one hundred percent of cases are fatal. If you start therapy in a timely manner, then the outcome depends on the stage and rapidity of the progression of the disease. Medicine has enough a wide range methods and means of treating tuberculosis, and their use is the key to a favorable prognosis.

One of the most severe complications of cerebral tuberculosis is the development of hydrocephalus, provoked by vasculitis and softening of tissues in the affected area, which leads to the formation of adhesions in the meninges.

Causes and prevention

It must be understood that the ability for mycobacteria to overcome the blood-brain barrier appears under a combination of certain conditions. First of all, this is a decrease in general and local immunity. In addition to contact with a patient with tuberculosis, the social factor also plays a role. These are poor living conditions, the use of alcohol and drugs, malnutrition. Also, the causes of cerebral tuberculosis may be the presence of severe infectious diseases in the patient.

Prevention of occurrence this disease is to manage healthy lifestyle life, giving up bad habits (alcohol, nicotine, drugs), observing timely and nutritious nutrition, as well as increasing the body's immune defense, avoiding contact with tuberculosis patients.

Meningitis in children and adults is very serious illness often with a poor prognosis. Its symptoms are provoked by a viral or bacterial infection, and the inflammatory process is localized in the tissues of the meninges. But if meningitis is caused specific infection, it is easily transmitted from a sick person, may respond poorly to treatment, and, therefore, is even more dangerous.

Tuberculous meningitis in adults and children is an inflammation of the meninges of the brain, occurring as a secondary disease against the background of existing tuberculosis of the lungs or other organs. The vast majority of patients had tuberculosis before or currently has an active infectious process. The causative agent of the disease enters the cerebrospinal fluid, and from there - into the soft, arachnoid or even dura mater, causing their inflammation.

Tuberculous meningitis can be called a complication of primary tuberculosis. Initially infectious particles cause sensitization nerve cells to their toxins, as a result, the blood-brain barrier will be broken, and the vessels of the meninges will become infected. After the introduction of infection from the vessels into the cerebrospinal fluid, the tissues of the meninges themselves become inflamed. In addition, the disease leads to the formation of small tubercles in the brain and membranes, which can grow into the bones of the skull and spread through the cerebrospinal fluid to the spine. In patients, diagnosis often also reveals the presence of a gray, jelly-like mass at the base of the brain, narrowing and blockage of the arteries, and a host of other severe disorders.

Causes and ways of transmission of the disease

The causative agent of pathology is Mycobacterium tuberculosis. These bacteria are very pathogenic, but not every person, if they enter the body, will cause an infectious disease. Their virulence - the ability to infect - is highly dependent on environmental conditions, as well as immunity and general human health. Initially, the patient develops tuberculosis of such localizations:

Lungs
lymph nodes
Kidney
Bones
Intestine

Over time, a specific inflammation occurs in children or adults, which is reduced to the appearance of accumulations of mycobacteria in the form of granules, prone to decay and penetration of infection into distant organs. In a patient, tuberculous meningitis can occur at any time during the course of tuberculosis or after its ineffective treatment has been carried out.

Symptoms of this pathology can appear if healthy man contracted from a patient with an open form of tuberculosis by airborne droplets, through food, kisses. In rural areas, the alimentary route of transmission of tuberculosis is common. Risk factors for the development of the disease include all types of immunodeficiencies. Especially often meningitis develops in children with somatic diseases, in those who have undergone rickets, and who have been operated on. In adults, the disease is more often observed with HIV infection and drug addiction, malnutrition, alcoholism, after a traumatic brain injury, with general exhaustion, in old age. In some cases, it is not possible to establish the source of infection, the cause of the disease and the location of the primary focus.

How does tuberculous meningitis manifest itself?

In children, any type of meningitis is more common than in adults. If a mother is ill with tuberculosis, an infant can also suffer from this disease, moreover, with serious consequences for life and health. Symptoms of a pathology such as tuberculous meningitis begin to appear after infection enters the liquor - cerebrospinal fluid. They develop in stages, according to three periods (prodromal, irritation period, terminal).

In most cases, the disease in both children and adults begins slowly and develops up to 6-7 weeks, but in severely weakened people, a sharp, acute onset is possible. Signs of the first period of meningitis are as follows:

Apathy, Bad mood, lethargy
Tearfulness, refusal to breastfeed (in young children)
Subfebrile body temperature
Dizziness
Nausea, vomiting
constipation
Urinary retention

Symptoms of the next stage of tuberculosis are due to the fact that the cerebrospinal fluid transfers the infection directly to the meninges (approximately by the end of the 2nd week).

They are like this:

Further increase in temperature (up to 39-40 degrees)
Sharp pain in the neck or forehead
, dizziness
Photophobia
Depression of consciousness, fainting
Stopping the passage of feces
Increased skin sensitivity
The appearance of bright red spots on the chest, face
Neck muscle tension
Deafness, visual loss, strabismus, etc.

The terminal stage is caused by the fact that the inflammatory process damages parts of the brain. Edema occurs - hydrocephalus, as liquor and inflammatory transudate accumulate in the tissues and do not flow. Often there is a blockade of the spinal cord, paresis and paralysis, tachycardia, impaired consciousness and breathing. By 15-24 days, tuberculous meningitis in children and adults, if not treated, leads to death from central paralysis - damage to the vascular and respiratory centers.

Diagnostics

In order for treatment to be able to save a person, it is important early diagnosis this pathology. It is believed that the period of a relatively safe state is no more than 7-8 days. To suggest the development of meningitis should be the presence of the underlying disease - tuberculosis, as well as the existing symptoms.

Diagnosis of the disease in children and adults should include a number of physical, laboratory, instrumental examinations:

Inspection, palpation of the lymph nodes;
Radiography of the lungs;
Ultrasound of the liver and spleen;
Tuberculin tests;
General blood analysis;
Blood test by ELISA for tuberculosis;

The main source for finding infection in the diagnosis of "tuberculous meningitis" is cerebrospinal fluid. The patient's cerebrospinal fluid is taken for analysis during a lumbar puncture. As a rule, the pressure of cerebrospinal fluid in meningitis is high, so it can leak out. Confirms the diagnosis of cerebrospinal fluid, in which the concentration of protein, lymphocytes, high cellular composition, glucose is too low.

Unfortunately, the cerebrospinal fluid does not always contain Mycobacterium tuberculosis, which could be detected after bakposev, but during the analysis by the flotation method, they are usually detected, and the diagnosis is confirmed. Differential Diagnosis with a pathology such as tuberculous meningitis, should be carried out with viral meningitis, bacterial meningitis.

How to treat tuberculous meningitis

With this disease, urgent hospitalization and inpatient treatment is necessary. Children and adults are placed in a specialized department or initially in an intensive care unit (depending on the condition). The duration of therapy is most often at least 6-12 months. For the most part, treatment revolves around the use special preparations- Pyrazinamide, Rifampicin, Isoniazid and other drugs from the phthisiology section.

Additionally, treatment includes drugs to improve blood microcirculation, normalize cerebral circulation, antioxidants, drugs against brain tissue hypoxia.

In order to avoid cerebral edema, the treatment of a disease such as tuberculous meningitis is often based on the use of decongestants and diuretic drugs. To reduce the effects of intoxication, the patient is infused saline, glucose. It must be remembered that with tuberculosis, even after a successful recovery, a person is weakened and needs rehabilitation measures. Most people are recommended to visit specialized sanatoriums, home exercise therapy, massage. Proper nutrition is very important - a diet with an abundance of protein foods, vegetable and animal fats.

Prevention of tuberculosis is very important, because this disease is one of the most serious among infectious pathologies and is fraught with death or disability. Everything must be done to protect children and all loved ones from infection, vaccinate on time and prevent weakening of the immune system.

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