Spinal intramedullary tuberculoma in a 3-year-old girl

Background: Spinal intramedullary tuberculoma (IMT) is a rare manifestation of extrapulmonary tuberculosis (TB). Presentation of TB in the pediatric age group is a significant contributor to mortality. Case Description: A young vaccinated girl presented to the neurosurgery department with difficulty walking and urinary incontinence. A magnetic resonance imaging performed outside the hospital showed a hyperintense intramedullary lesion extending from T6 to T9. The patient underwent T6–T9 laminoplasty with intramedullary lesion decompression under neuromonitoring. The dense adherence of the lesion to the cord and nerve roots permitted only debulking. Histopathological examination confirmed the diagnosis of tuberculoma. The patient was started on antitubercular treatment and was then subsequently discharged. After 8 months, the patient was reviewed and showed improvement in her symptoms and complete resolution of the lesion on imaging. The patient has now developed hydrocephalus on the latest computed tomography imaging, which may be due to tubercular meningitis or arachnoiditis. Conclusion: Complete resolution of spinal IMT is possible with a combined treatment approach.

ATT-Therapy Induced DRESS: A Case Report

A severe adverse reaction called Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS syndrome), is usually described by eosinophilia, fever, swollen lymph nodes, severe skin rash and extensive systemic association. It is distinguished by a lengthy latency period, which is characteristic drug reaction with eosinophilia and systemic symptoms (DRESS). Formerly known as drug-induced delayed multi-organ hypersensitivity syndrome (DIDMOHS) or drug-induced hypersensitivity (DIHS). There are a variety of clinical symptoms associated with the syndrome yet it is still poorly understood. Drugs most commonly implicate in Anticonvulsants are the most common cause of DRESS syndrome, followed by sulfonamides and a variety of anti-inflammatory medications.Anti-tubercular therapy (ATT) is rarely associated with DRESS syndromeWe present the case of a 60-year-old female patient who had previously been treated with Anti-tubercular Therapy for Tubercular Meningitis (ATT).She was admitted to the hospital with presenting complaints of vomiting, burning micturition, fever associated with chills, generalized swelling and reddish skin all over the body including facial puffiness. The problem was successfully resolved by refraining from the offending medication and administering supportive care. Thus, the case illustrates the necessity of considering anti-tubercular drug reactions even when symptoms are delayed. Keywords: Anti-tubercular Therapy (ATT), Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS), Adverse drug reaction (ADR), Drug-induced, Systemic symptoms syndrome,

A STUDY ON ADENOSINE DEAMINASE AND C-REACTIVE PROTEIN IN CEREBROSPINAL FLUID OF MENINGITIS PATIENTS OF DIFFERENT TYPES.

Introduction: The three commonest types of Meningitis are Bacterial, Viral and Tubercular; they differ in their pathophysiology and management. That is why early differentiation between them is important. Bacterial meningitis have heavy fatality rates whereas Tubercular meningitis inicts severe neurological sequalae. Aims & Objectives: To determine whether ADA and CRP can be used successfully to predict the type of Meningitis affection Methodology: This is a Hospital based cross-sectional observation study which was undertaken in Biochemistry dept. Medical College, Kolkata. Eighty cases of meningitis were taken. ADA and CRP was measured along with Protein, Sugar and Differential staining cell counting. The cases were divided into three groups (Bacterial, Viral, and Tubercular) on the basis of microscopic and Biochemical Examination. Results & Analysis: ANNOVA test was done along with Bon Ferronis Test which revealed that there was signicant difference in mean of ADA & CRP in the three different groups.ROC curve for CRP between Reactive and Non-reactive meningitis revealed that if CRP values are more than 11.0, 95% of the cases were reactive whereas ROC curve for ADA between Tubercular and Non Tubercular forms showed when the concentration was more then 9.0, 95% of the cases were of Tubercular origin. Conclusion: When taken together ADA and CRP successfully predict the type of Meningitis. It is also helpful in diagnosing those cases when the Cell count and type was equivocal.

Case Report on Tuberculosis Meningitis-A Nurses Perspective

Mycobacterium tuberculosis is the bacteria that cause tuberculosis. If the infection is not treated immediately the bacterium passes via the circulatory system and spread other organs and tissues. Pathogen will travel to the meninges and causes inflammation of membranes called as tubercular meningitis. Here, the authors report a case of tuberculous meningitis a 42- years-old male patient with the chief complaints of low grade fever with chills since 1 month, headache in frontal region since 5-6 days, altered sensorium, breathing difficulty, reduced speech and left side weakness of the body since 1 day. After admitting in the ward all investigation done like MRI brain, ECG, lumbar puncture, blood tests etc. and he diagnosed as tuberculous meningitis. Patient admitted in AVBRH in ICU, investigations done, where patient was on NIV support, nasogastric tube, foleys catheter and it has been removed as patient was improving the condition and shifted in ward. Patient medical treatment in the ward was inj. C-tri 2 gm, Inj.levoflox 500 mg, inj. thimine 100 mg, Inj.Dexamethasone 10 mg, tab. Pan 40 mg, tab. Akt4 3, Inj.manitol, tab. Lorazepam. History collection, Physical examination, neurological assessment and nursing care plan were done after all treatment patient condition has been improved.

Operated case of tubercular meningitis with hydrocephalus in an immunocompromised patient and acute abdomen-management controversy: a case report

Tuberculosis is a very common infectious disease in developing countries like India. Most common form includes pulmonary tuberculosis. Other common forms are tubercular meningitis and intestinal tuberculosis. Hydrocephalus is one of the commonest complications of tubercular meningitis. We present a HIV positive case who had tubercular meningitis with hydrocephalus and was operated for ventriculoperitoneal shunting, later developed intestinal tuberculosis with perforation peritonitis. The presentation of an acute abdomen with a ventriculo-peritoneal shunt requires skillful diagnostic workup and management. Apart from complications caused by the shunt, primary abdominal pathological conditions must be taken into consideration. Tuberculosis has multiple presentations all of which should be kept in mind.

CLINICORADIOLOGICAL CORRELATION OF PEDIATRIC AND NEONATAL SEIZURES

INTRODUCTION:Epilepsy is the most common serious disorder worldwide. It has no age,racial,social class,national or geographic boundaries. AIMS AND OBJECTIVES:To study imaging ndings of various pathologic conditions seen in epileptic children and neonates. MATERIALAND METHODS:Aprospective study was obtained from evaluation of 40 patients presenting with epilepsy in paediatric OPD and IPD. Head CT was obtained in 15 (37.5%), MRI in all cases. Contrast was given in patients with tumour, suspected vascular malformations, inammation, and Infectious pathology. Epilepsy provoked by causes such as fever, electrolyte imbalance and dehydration were excluded . RESULTS:The most common cause of epilepsy in our study was tuberculosis in this region, being at 22.5% which consisted cases of both tuberculoma and tubercular meningitis. This was followed shortly by neurocysticercosis at 15%. This was followed by Hypoxic Ischemic Encephalopathy at 10%. CONCLUSION:Imaging of children with epilepsy is a challenging subject and requires an understanding of the wide spectrum of pathology that affects the paediatric population

Diffuse leptomeningeal glioneuronal tumor with high-grade features masquerading as tubercular meningitis—a case report

Background Diffuse leptomeningeal glioneuronal tumor (DLGNT) has been recently described in the literature. The complete neuroimaging spectrum and histopathological characteristics of this entity are yet to be elucidated. In an endemic region, diffuse leptomeningeal enhancement on neuroimaging with associated communicating hydrocephalus is usually suggestive of infective meningitis and the patients are started on empirical anti-microbial therapy. However, it is important to consider other differential diagnosis of leptomeningeal enhancement in such cases, particularly if the clinical condition does not improve on anti-microbial therapy. An early diagnosis of a neoplastic etiology may be of particular importance as the treatment regimens vary considerably depending on the underlying disease condition. Case presentation In this case report, we describe a case of DLGNT with high-grade histopathological features which was initially managed as tubercular meningitis based on the initial neuroimaging findings. Due to worsening of the clinical course and subsequent imaging findings at follow-up, a diagnosis of DLGNT was considered and subsequently proven to be DLGNT with features of anaplasia on histopathological examination of leptomeningeal biopsy specimen. Conclusion This case highlights the importance of recognizing certain subtle finding on MRI which may help in an early diagnosis of DLGNT which is crucial for appropriate treatment.