Grand rounds and Teaching Files - Pediatric Oncall
Demyelination in tuberculous meningitis

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Ira Shah
Consultant in Pediatric Infectious Diseases and Pediatric Hepatology, Nanavati Hospital and Incharge Pediatric HIV, TB and Liver Clinics, B J Wadia Hospital for Children, Mumbai, India.

Address for Correspondence: Dr Ira Shah, 1, B Saguna, 271, B St Francis Road, Vile Parle {W}, Mumbai 400056.

Clinical Problem:
A 7 years old girl presented with fever for 15 days, and 1 episode of generalised tonic clonic convulsion followed by loss of consciousness. Her sister was suffering from fibrocavitatory TB and was on treatment with anti-tuberculous therapy {ATT} from 3 months. On examination, the patient was comatose, had neck stiffness and spasticity of bilateral lower limbs. Cerebrospinal fluid {CSF} showed 300 cells, cumm {5 percent polymorphs, 95 percent lymphocytes}, 105 mg, dl of proteins and 20 mg, dl of sugar. CSF GeneXpert was positive for mycobacterium tuberculosis and was sensitive to rifampicin. She was started on 4 drug ATT along with steroids {for 2 months}. She responded to the same, but subsequently after 3 months of therapy, she presented with abnormal movements and behavioural problems. MRI brain showed extensive demyelination.

How common is demyelination in CNS TB_? How should it be treated_?

Answer Discussion :
benketira Abdelkader
It si vert rare
Vaut thé treatment must contain streptomycin injectable or even intrathecal
And the duration of treatment should be extended
Clinically if the neurological symptoms persist we can use bonus of corticosteroids
1 g, kg three bolus
Images of irm persist 3to6 months perhaps more


17 hours ago
IV Methylprednisolone for 5 days followed by oral prednisolone for four weeks. ATT to be continued. Demyelination with CNS TB is rare. One adult case reported in Kashmir.
2 Days ago
naglaa mousa
ATT+corticosteroid +anticonvulsant
9 Days ago
trusha joshi
its rare in cns tb and treated with methyprednisolone
9 Days ago
muhammad rashid
uncommon treated with steroids along with Rifadin isoniazid
13 Days ago
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