TUBERCULOUS MENINGITIS

Tuberculous meningitis manifests extra pulmonary tuberculosis caused by the infection of the meninges with the bacilli of Mycobacterium tuberculosis. Tuberculosis is a contagious, airborne disease that typically affects the lungs.

In tuberculous meningitis, the meninges are infected by tuberculi baccili and form sub-ependymal collections called Rich foci. These foci can rupture into the subarachnoid space and cause an intense inflammatory response that causes meningitis symptoms. The exudates caused by this response can encase cranial nerves and cause nerve palsies. They can entrap blood vessels causing vasculitis, and block cerebral spinal fluid (CSF) flow leading to hydrocephalus.

RISK FACTORS:

• HIV/AIDS
• excessive alcohol use
• weakened immune system
• diabetes mellitus
• history of previous infection of tuberculosis

PATHOPHYSIOLOGY: 

 The foci can rupture into the subarachnoid space and cause an intense inflammatory response that causes meningitis symptoms. The exudates caused by this response can encase cranial nerves and cause nerve palsies which can entrap blood vessels causing vasculitis, and block cerebral spinal fluid  flow leading to hydrocephalus, which may be communicating or non-communicating. These immune responses can lead to complications associated with tuberculous meningitis.

SYMPTOMS:

Three distinct phases of clinical presentation are usually found.

1. The early prodromal phase is characterized by the insidious onset of low-grade fever, malaise, headache, and personality change. It usually lasts for one to three weeks.
2. It is followed by the meningitic phase,

Characterized by prominent neurologic features, such as protracted headache, vomiting, meningismus, lethargy, confusion, and varying presentation of cranial nerve and long-tract signs.

1. Confusion gives way to stupor, seizures, coma, and often hemiparesis in the paralytic phase

DIAGNOSIS:

• biopsy of the meninges
• blood culture
• chest X-ray
• CT scan of the head
• skin test for tuberculosis.
• CSF analysis
• CT scan
• MRI

HOMOEOPATHIC MANAGEMENT:

• Belladonna - It is well indicated for meningitis in the first stage. There is fever with dry heat. The head feels hot and painful with a throbbing sensation and flushed face. The person may want to bore his head in the pillow. Nausea and drowsiness are also marked.
• Apis Mellifica – There is marked irritability, crying and screaming loudly. Confusion, dullness, and dizziness are also present. Intense pain in the back of the head is most prominent. Another important accompanying symptom is an inability to hold the head erect and boring of the head into the pillow. Diplopia and obscuration of vision also appear. Its use is also highly considered in cases of meningitis with hydrocephalus (build-up of fluid in the brain cavities).
• Stramonium – The pain in head and nausea predominates in cases of meningitis. The eyes are markedly red and inflamed along with delirium. In some cases, there may be irritability with screaming, striking with hand feet, and a tendency to strike/bite others. Convulsive movement of the limbs is also well noted with the above features.
• Veratrum Viride – Veratrum Viride is helpful for meningitis with a high fever. This is attended with the rolling of the head and frequent vomiting. Pain in the nape of the neck is also present and the person cannot hold the head.
• Gelsemium – It is helpful for meningitis in the initial stage, along with severe chills. There is marked stiffness of the neck. A headache with a sensation of band tightly binding head is present. This is attended with great exhaustion and intense drowsiness. There is a desire to lie still. Vertigo along with a staggering gait may also appear. Jerking of the body, especially of the left side, may occur while falling asleep.
• Helleborus – It is prominently indicated for meningitis when the neck feels rigid and there is marked drowsiness. Fever with chills and vomiting may also occur. The head feels heavy and heated. Frequent convulsions in meningitis are also a guiding feature to use Helleborus. This medicine is also indicated for meningitis with hydrocephalus.
• Rhus Tox – meningitis with pain and stiffness of muscles and joints. This is accompanied with marked anxiety and restlessness. High fever and pain in the head are present, that extends to the ears. Rash on the body is also present.
•  Zincum Met – Meningitis with a sharp pain in the head. The person may want to roll and bore the head in the pillow. Automatic motion of hands may appear with the motion of the head. Pulse is small and frequent. It is also useful for hearing loss after meningitis.