A Case Series of Tubercular Meningitis at Tertiary Care Center: A Retrospective Study

INTRODUCTION Tuberculosis, a disease that has afflicted mankind since ancient times, is still a major public health problem in many parts of the world, especially in the developing countries of Asia and Africa. Tuberculosis can affect any part of the nervous system including meninges, brain and spinal cord. Tuberculous meningitis is by far the most common manifestation, accounting to 70 % to 80 % of all cases of Neurotuberculosis. This study aimed to see the clinical presentation, complication and prognosis of tuberculous meningitis patients in tertiary level hospital of mangalore, Karnataka. METHODS A retrospective clinical case series of 41 patients was carried out in the department of medicine, K. S. Hegde medical academy mangalore Karnataka from December 2013 to December 2017. Data was collected from medical records and presenting complaints, examination findings, laboratory findings, imaging reports and including treatment and complications details was noted. RESULTS In the present study, forty one patients were enrolled. Among the patients (22 %) were aged between 15 to 30 years, (12 %) were aged between 31 to 40 years, (29 %) were aged between 41 to 50 years, (10 %) were aged between 51 to 60 years and (27 %) were aged above 60 years. Regarding gender 54 % were males and 46 % were females. Most common symptom of presentation was fever 85 % and other symptoms like headache (73 %), vomiting (56 %), altered sensorium (39 %). The distribution of the patients based on the examination findings showed, 85 % had neck rigidity, kernig sign was present in 65 % and 26 % had cranial nerve involvement and 26 % showed long tracts involvement. In relation to the general condition at the presentation to the hospital, 25 % patients had GCS less than 8, 33 % had GCS 8 to 12 and 42 % had GCS above 12. on CSF analysis 91 % had lymphocyte predominant cell count and 70 % patients had low glucose level in the CSF analysis. The most common complication of TB meningitis observed was persistent headache 31 %, seizures in 17 %, cranial nerve palsy in 12 %, hemiparesis in 14 % and decreased cognitive function in 17 % and prognosis was good in younger the age, no comorbidity, GCS above 8 and earlier identification and initiation of ATT. CONCLUSION clinical presentation and neurological examination is very helpful in diagnosing a Tubercular meningitis. In-spite of most of the time imaging study showing normal study, Diagnostic Lumbar puncture and CSF analysis in a clinically suspected patient plays a vital role in making a diagnosis of Tubercular Meningitis. Early diagnosis and initiating ATT was associated with reduced complications and overall good prognosis.