Author : Kughan Govinden*, GB Eow, CF Cheah
Tuberculous meningitis (TBM) is the most devastating consequence of infection with Mycobacterium tuberculosis (TB). Approximately a third of patients die soon after presenting to hospital, and many of those surviving are left with severe neurological sequelae. Due to high suspicion for Tuberculous Meningitis based on CT Brain findings and his social history (citizen from a country with high incidence of TB and father was treated previously for pulmonary TB), his CSF sample was also sent for GeneXpert MTB/RIF. CSF GeneXpert MTB/RIF showed MTB detection at low level with no rifampicin resistance. Patient was commenced on anti-TB medications (Isoniazid, Rifampicin, Streptomycin and Pyrazinamide). patient had an episode of reduced responsiveness with drop in Glasgow Coma Scale up to 9/15 during admission. Therefore, another CT Brain was repeated, which showed presence of non-resolving hydrocephalus after ELD removed. Therefore, a ventriculo-peritoneal (VP) shunt was inserted. His GCS improved up to 13/15 (did not completely resolve) after VP shunt was inserted. This patient suffered Stage 2 of TB Meningitis based on British Medical Research Council Classification. Despite early initiation of therapy and VP shunt insertion, patient still had several neurological deficits such as incomplete recovery of GCS, bilateral 6th nerve palsies and dysphagia upon discharge. Key words: TB Meningitis, genexpert, anti-TB medications, VP-shunt.
Dr. Arend L Mapanawang, Sp.PD, FINASIM, PhD