Professional Documents
Culture Documents
S(K), MKT
Dept. of Neurology Medical Faculty, Universitas Sumatera Utara
In developing countries :
* CNS TB- younger age group, usually Childhood (< 3 yo).
* In children, dissemination usually occurs early risk of
CNS TB is highest in the first year following infection.
* Risk factors: malnutrition, recent measles, HIV
INTRACRANIAL
Tuberculous Meningitis (TBM)
TBM with milliary tuberculosis
Tuberculous Encephalopathy
Tuberculous Vasculopathy
Space-occupying lesions: Tuberculoma ( single or multiple),
tuberculoma with milliary tuberculosis, tuberculous abscess
multiple
small
SPINAL
Potts spine and Potts paraplegia
Tuberculous arachnoiditis (myeloradiculopathy)
Non-osseous spinal tuberculoma
Defenition: Infection
underlying brain by
Mycobacterium tuberculosis
11
PATHOGENESIS
DROPLET INHALATION
ALVEOLAR MACROPHAGE
DISSEMINATION to the regional
lymph node
10% PPT
Miliary TB
PRIMARY
PRIMARY COMPLEX
COMPLEX
MENINGITIS
Bacteremia
Seed to the meninges
Or brain parenchyma
RICH FOCI
PATHOGENESIS
Innoculation of bacilli into the subarachnoid space
OBLITERATIVE
VASCULITIS
ADHESION FORMATION
Encephalitis/
myelitis
Interpendicular fossa
Obstruction of the CSF
CLINICAL FEATURES
Headache, Lethargy, Confusion, Drowsiness
Fever, Stiff Neck, Kernig and Brudzinski signs
ANALYSIS OF CSF
Pressure: increased
Cells: 50-500 white cells/mm3; lymphocyte
predominate
Raised Protein: 1-2 gr/l
Glucose: < 2,22 mmol/ l (< 40 mg/dl)
FUTURE OF DIAGNOSIS
o History of treatment of TB
o TB extra-organ (clinically and radiology)
Based approach
Scoring system
Kategori diagnostik
Ogawa (1987)
Definite: BTA ditemukan di CSS (pewarnaan langsung
atau kultur), dan/atau didapatkan BTA pada otopsi
Probable:
Pleositosis di CSS
Hasil kultur bakteri dan jamur negatif
Ditambah satu dari hal-hal berikut:
Kategori diagnostik
Thwaites
MTB definite:
Kategori diagnostik
Thwaites
MTB probable:
Kategori diagnostik
Thwaites
MTB possible:
Stage I
Stage II
Stage III
2 weeks
2 weeks
History of TB Contact
56 (45-70%)
28 (2 -80%)
72 (50-95%)
51 (40-70%)
61 (35-75%)
45 (25-55%)
CT Scan/MRI
Enhancement of the basal cisterns 90% of cases
interpeduncular fossa, the ambient cistern & Chismatic
regions are particularly involved
Communicating hydrocephalus in 50-80%
Infarct on CT -20,5-38%, most common basal ganglia and
the territories of the medial striate and thalamoperforating
arteries
MRI more sensitive than CT- meningeal ( basal enhancement)
and parenchymal (infarct) involvement, hydrocephalus
detected equaly by CT and MRI
DRUGS
Dosage Child
Dosage Adult
Route
Isoniazid
10 20 mg/kg
( max 500 mg)
300 mg
Oral
Rifampicine
10 20 mg/kg
(max 600 mg)
450 mg (< 50
kg)
600 mg (> 50
kg)
Oral
Pyrazinamide
30 35 mg/kg
(max 2gr)
Oral
Ethambuthol
15 20 mg/kg
(max 1 gr)
15 mg/kg
Oral
DRUGS
Daily
Dose
Mg/ kg
Serum
Ug/dl
Normal
Meningens
Ug/ms
Inflammated
menigens
ug/ms
Isoniazid
5 - 10
3-5
0,6- 1,6
2,0 3,2
Rifampicine
10 - 20
0,4 1,2
0,4-1,0
Ethambutol
15 - 25
1,0 -7,7
0,5-2,5
Pyrazinamide
25 - 30
15 - 50
10
30 50
Streptomycine
15 - 40
25 50
trace
2.0 9.0
INTRACRANIAL
EXTRACRANIAL
Electrolyte
imbalance:hyponatremia
Rekomendation B, II
Kadar CD4
>200 sel/l
100-200 sel/l
<100 sel/l
tuberculosis