| Meninges, i.e. thin layers/membranes (3 in number, | | | | rupture of tuberculoma into the subarachnoid space. |
| named from outside to inside, (i) the dura mater, (ii) | | | | An early diagnosis and treatment of tuberculous |
| the arachnoid mater and (iii) the pia mater) covering | | | | meningitis is most important in order to save the |
| the brain may also be involved as a result of | | | | patient from various neurological deficits. It should be |
| tuberculosis, and the disease is called tuberculous | | | | treated as a medical emergency. A delay in |
| meningitis. In this case, the infection spreads from | | | | treatment could result in permanent disabilities. Initially, |
| the brain to the meninges. Initially, a slow-growing | | | | the patient gets vague symptoms like malaise, loss |
| tuberculous lesion called 'tuberculoma' develops in the | | | | of appetite, a vague headache, irritability, and soon |
| brain, adjacent to the meninges, which ruptures in the | | | | he gets the so-called symptoms and signs of |
| subarachnoid space, i.e., the space between the | | | | meningial irritation, as a result of the tuberculous |
| second and third layer/meninx, causing infection of | | | | infection of the meninges, like a persistent headache, |
| the meninges, leading to the signs and symptoms of | | | | vomiting, neck rigidity / stiffness, etc. Stiffness of |
| tuberculous meningitis. | | | | the neck is a valuable sign of this disease, and the |
| It was sometimes thought that there is a true entry | | | | rigidity of the neck gives the clinical clue to the |
| of the tubercle bacilli from this 'tuberculoma' into the | | | | diagnosis of tuberculous meningitis. Another important |
| subarachnoid space. The author discussed this aspect | | | | sign is that the patient cannot extend the leg after |
| in detail with related case reports, with Dr. William | | | | the thigh has been flexed, or brought close to the |
| Boyd (Canada), a renowned pathologist, who has also | | | | abdomen (called Kernig's sign). Of course, this is |
| written Text Book of Pathology as well as Pathology | | | | usually elicited by the physicianl neurologist while |
| for the Physician. In one of his communications to the | | | | examining the case in detail. |
| author, while finally approving that there is indeed a | | | | It is important to recognize all the early signs and |
| rupture of tuberculoma into the subarachnoid space, | | | | symptoms of tuberculous meningitis before the |
| he wrote, "Needless to say, I was most interested in | | | | disease advances. All the relevant tests must be |
| your case of focal epilepsy followed by tuberculous | | | | carried out to locate the lesion of tuberculosis in |
| meningitis. It seems to me that your idea of a | | | | other parts of the body, especially in the lungs. An |
| tuberculoma rupturing and discharging bacilli into the | | | | examination of the cerebrospinal fluid (CSF), including |
| subarachnoid space is the most reasonable one". In | | | | the computed tomographic (CT) scanning of the |
| the case of the patient, discussed with Dr. Boyd, the | | | | head, is also required for the diagnosis of tuberculous |
| patient developed focal epilepsy as a result of | | | | meningitis. Once diagnosed, the patient should be |
| tuberculoma in the brain, and thus primarily presented | | | | immediately put on suitable antituberculosis treatment |
| the signs and symptoms of epilepsy, and later, as a | | | | in proper dosages, for a suitable period, so as to |
| case of tuberculous meningitis after the probable | | | | eradicate the infection of tuberculosis from the brain. |