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Differences in Central Nervous System Tuberculosis in Children.pptx
- 1. Differences in CentralNervous System Tuberculosis in Children Vs Adults
- 2. CNS TUBERCULOSIS • DrAshwani K Sood
- 3. • One ofthe most devastating clinical manifestation of EPTB. • 5-1Oo/o of extra-pulmonary & I% of all TB cases. • Male predominance • The case fatality rate is 1OOo/o on untreated case and delayed in treat1nent may lead to permanent neurological damage. Introduction
- 4. CONTENT • Etiology • Pathogenesis •Classification • Diagnosis • Treatment
- 5. Etiology ►Causative agent; • Most- Mycobacteriu1n tt1bcrct1losis • In im1nunoco1nro1nised patient - Atypical Mycobacteria ; MAC, n1ycobacterit1111 intraccl lt1larc ►Risk factors; Children> adults HIV co-infection Malnutrition • Alcoholics • Malignacies Use of • • Immnosuppressive agents
- 7. Pathogenesis !.DROPLET INFECTION 2.Area of EXTRA CRANIAL EPTB Primary focus bacteremia Meninges and brain parenchyma 1 RICH FOCU S ( subependymally located tubercle) l
- 9. lntracranial - Tubercular 1neningitis Tuberculo1na -Tubercular abscess Tuberct1lar enccpl1alopathy Tubcrcttlar vasculopathy Spinal - - - Pott's spine & Pott's paraplegia Tt1bercular arachnoiditis Spinal tt1berc1lion1a Spinal meningitis Classification
- 11. Symptoms • Fever Sign • Neckrigidity • Kerning sign Altered sensoriu,n Headache Vo1niting Hemiplagia Behavioural changes Papi IIoedema Seizure Abducens nerve palsy • • • • • • Weight loss Optic atrophy Facial nerve palsy Oculomotor nerve palsy • Brudzinski sig11 • • • • • • Chhoroidal tubercle Clinical features
- 12. Staging of TBM BritishMedical Research Council criteria Stage I: Prodro1nal phase with no definite neurologic sy1nptoms. Stage II: Signs of n1eni11geal irritation with slight or no clouding of sensorium & minor or no neurological deficit. Stage III: Severe clouding ofsensorium, convulsions, focal neurological deficit & involuntary 1nove1nents.
- 13. Modified MRC criteria GradeI: Alert and oriented (GCS 15) without focal neurological deficit. Grade II: GCS 14-10 with or without focal neurological deficit or GCS 15 with focal neurological deficit. Grade Ill: GCS less than 10 with or without focal neurological deficit.
- 14. Spinal TBM May result fromruptt1re of Rich foci in the spinal aracl1noid space The acute form presents with fever, headache, and root pains acco1npanied by myelopathy The chro11ic form presents with spinal cord compression
- 15. Complications • Hydrocephalus comn1unicating ,non communicating • Ocular lesion papiloede1na, optic atrophy, vision loss, • Hypothalamic pituiatary syndrome SIADH hyponatraen1ia (49%) Diabetes incipidus persistent pyrexia • Cranial nerve palsies 3rd 4th, 5th 6th 7th horizontal & vertical gaze palsy ' ' ' ' Internuclear ophtl1almoplegia • Paralysis & abnormal movement • Stroke ,seizure
- 16. CNS TUBERCULOSIS • DrAshwani K Sood
- 17. • One ofthe most devastating clinical manifestation of EPTB. • 5-1Oo/o of extra-pulmonary & I% of all TB cases. • Male predominance • The case fatality rate is 1OOo/o on untreated case and delayed in treat1nent may lead to permanent neurological damage. Introduction
- 18. CONTENT • Etiology • Pathogenesis •Classification • Diagnosis • Treatment
- 19. Etiology ►Causative agent; • Most- Mycobacteriu1n tt1bcrct1losis • In im1nunoco1nro1nised patient - Atypical Mycobacteria ; MAC, n1ycobacterit1111 intraccl lt1larc ►Risk factors; Children> adults HIV co-infection Malnutrition • Alcoholics • Malignacies Use of • • Immnosuppressive agents