50 years old tuberculous meningitis symptoms?

summary

Meningitis is not the patent of children, so everyone needs to pay attention, especially when the high fever does not subside for several days. Recently, BMJ case rep magazine published a case of tuberculous meningitis. The patient showed abnormal behavior for one year, which is one of the rare manifestations of tuberculous meningitis. What about the 50 year old patient with tuberculous meningitis?, Now let's take a concrete look.

50 years old tuberculous meningitis symptoms?

First, physical examination showed lethargy, emaciation and dehydration. The Glasgow Coma Scale score was 11 / 15. The muscle strength of the limbs was 3 / 5 grade, the muscle tension was increased, the reflex was active, and the pathological sign was negative. Neck ankylosis, negative for Kernig's and brudzinski's signs. Other physical examination showed no abnormality.

Second: chest X-ray, head plain scan and enhanced CT, MRI and EEG were normal. Blood routine showed thrombocytopenia (145 × The white blood cells and hemoglobin were normal. Serum sodium was increased (157 mmol / L), other electrolytes were normal, CRP was slightly increased (14 mg / L), ESR was normal. Liver function, hepatitis virus, HIV and syphilis were negative, and antinuclear antibody and other autoantibodies were negative.

Third: for this patient, the first choice is to identify the causes of chronic meningitis, including bacteria, parasites, fungi and HIV infection. It is also necessary to exclude some non infectious causes, including autoimmune diseases (lupus erythematosus), vasculitis, drug factors and tumors. Meningitis is usually caused by small cell lung cancer and melanoma. But there are as many as 1 / 3 patients whose etiology is not clear. This patient was diagnosed as tuberculous meningitis because of negative screening results of other causes.

matters needing attention

1. Tuberculous meningitis involving the central nervous system is not common in tuberculosis infection. 2. The first symptoms of tuberculous meningitis are different, which may lead to the difficulty of diagnosis. 3. The possibility of tuberculous meningitis should be considered for all patients with behavior change more than 1-2 weeks, especially in areas with high incidence of tuberculosis. 4. Cerebrospinal fluid analysis can be used in suspected patients: patients usually see an increase in the number of lymphocytes and protein. 5. Imaging examination is very important for decision-making of empirical treatment.