Child With TBM With Hydrocephalus

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Rakesh Kumar, Binay Ranjan, Manjul Vijay Department of Pediatrics, Katihar medical college, Katihar...

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Question
My son at age 1 year was diagnosed with TBM with hydrocephalus. CT scan on day 1 showed obstructive hydrocephalus and all the ventricles were dilated. Infarcts were seen in the left basal ganglia and hypothalamus. There was meningeal enhancement of the left sylvian fissure. Basal exudae were prominently seen. +'ve CSF report. Low grade fever, irritability end mild right facial palsy preceded for around 20 days. Unfortunately doctors could not identify and was basically treated for winter viral infection(distaclor, timinic,reglan etc.) Child had projectile vomiting the whole night intermittently and finally went into convulsion. Upon being rushed to hospital was treated with midazolam and convulsion contained.(got treatment within 45 minutes from convl onset).A second convulsion followed briefly within 3 hrs. Child was treated with usual ATT and prednisolone. We refused shunt. Two months later steroid was tapered and stopped. Ethambutol and pyrazinamide were also stopped. Rifampicin and INH continued. Phenytoin @ 5ml bd continued from day 1. There was tonic & clonic seizures. Stiff neck. Diplopia. Child had hemiplegia initially but improved with physiotherapy and time. 4 months down the line a follow MRI showed significant reduction in the ventricular. old infarcts were seen and sylvian enhancement present. During the entire period the child however had dramatic clinical improvement. Today its 6 months down the line. The following problems persist_ 1.Right side weaker than left 2.Do not prefer right hand 3.Problem of coordination of fingers of RH WHILE GRIPPING. 4.Very mild rt facial palsy. 5.Has learned to walk. 6.All other cognitive milestones are normal, rather excellent. Question: What shall be the follow up for the rest of his life @ a)Medical b)physiotherapy c)social d)parental guidance e)anticonvulsant therapy( no convl after day 1)f)Diet g)Precautions? Additional information:- Patient:- Krris/ born on 17.12.2005 @ optional c/section Date of convulsion:-16.12.2006 Probable source of contamination:-12 yr old unvaccinated neighbour suffering from pulmonary TB. We are from an educated middle class background living in a railway colony.
Answer
Get his hearing also evaluated. He will need physiotherapy for a long time. There is always a risk of learning disabilities in the child. Medical treatment for TBM is usually for a year. Duration may be longer if disease does not come under control. Get his eyes checked every 6 monthly while on therapy. Anticonvulsants may be needed for at least 2 years after last seizure and then if EEG is normal may be tapered off. Back to All Questions

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