الفهرس 
Tuberculosis in infancy and childhood
Tubercu;ous and serous meningitisOnly 14 pages are availabe for public view
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Abstract
SUMMARY
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S-U-M-M-A-R-YNeurotuberculosis
continues to be a serious infection
in many developing countries. Infection may be
either primary or due to reactivation and may present
as subacute meningoencephalitis or a focal tuberculoma.
Unfortionatly. the diaiIQosis is often delayed until
the patient has reached the second stage when neck
rigidity and other neurological signs appear.
Although t.e diagnosis is easy if all the associated
signs, symptoms and laboratory results are typical, yet
the major problem lies in the fact that it is a difficult
infection to exclude.
Therfore, clinicians should have a high index of
suspicion in patientllwho present with early signs and
symptoms of meningitis as listlessness, irritability,
anorexia, vomiting,. loss of weight refusal to smile or
play, vague ill health, photophobia, or headache,
Persistance and oombination of several of these symptoms
should alert the clinician to the possibility of tuberculous
meningitis before the appearance of neck stiffness,
focal neurological signs, disturbance of consciousness
or convulsion.
Abnormal chest roentgenograms, positive tuberculin
skin tests, a history of contact and c.s.f. smear that
is positive for acid-fast bacilli are all valuable
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criteria when present.
Roberts, 1981 reported that 60% of patients wi th
tuberculous meningitis had completey normal chest
roentgenograms, 64% had negative tuberculin skin test,
only one patient had a history of contact with an active
case and non of c.s.f. were positive for acid fast
bacilli. Therefore; meticulous clinical examination
might point to a clue for proper diagnosis.
The mortality rate is higher in children who are
disoriented confused, stuporose er semiconscious and
highest in children who are comatosed.
The sequalae rate is highest in children with motor
neurological signs. The prognosis is bad in.children
when they d.velop changes in sensorium or positive
neurological signs (My~t~980) and some are left with
neurological damage.
The cross sectional anatomy of the brain shown on
computerized tomography facilitate accurate localization.
Intracerebral inflammation is associated with cellular
infiltration and oedema and allow detection by
computerized tomography at an early stage.
Inflammation causes alteration in vascularity of
blood vessels of blood brain barrier which can be
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recognised by contrast enhancement.
Although cerebral tuberculosis is essentially
clinically diagnosed and confirmed by c.s.f. examination,
all.cases show meningeal enhancement after I.V.
contrast media which can be of diagnostic significance.
However, computerized tomography is mainly of
value in detecting complications especially hydrocephalus
secondary to basal adhesion, subdural effusions,
cerebral absceas or infarction and oedema due to vascular
occulsion. All these complications necessitate prompt
neurosurgical mangement to achieve better prognosis,
and favourable recovery.
Empirical chemotherapy is often imperative and
procrastination in mangement can be dangerous. In
many cases steroid therapy have a vital role in ensuring
an acceptable outcome.
Discovery of meningitis in children serves as an
alarm signal to look for unsuspected active case in
close relatives or friends or in the school.