Facial Weak spot, Diplopia, and Fever in a 31-Yr-Outdated: An Atypical Case of Tuberculous Meningitis.
Cureus. 2017 Dec 07;9(12):e1918
Authors: Qavi AH, Imran TF, Hasan Z, Ilyas F
Tuberculous meningitis (TBM) is an an infection of the central nervous system (CNS) meninges that carries excessive morbidity and mortality. It is very important acknowledge, as sufferers might current with atypical signs. We describe the case of a 31-year-old man with a historical past of diabetes who introduced with a sub-acute onset of right-sided facial weak spot and proper gaze issue with diplopia. Historical past revealed low-grade fever, right-sided headache, fatigue and average weight reduction for the previous a number of weeks. The affected person didn’t report neck stiffness, rigidity, fever, chills or cough. The bodily examination revealed sixth nerve palsy with a proper Horner’s syndrome. Magnetic resonance imaging (MRI) of the mind confirmed pachymeningeal enhancement. A spinal faucet revealed elevated white blood cells (WBCs), glucose and protein; cerebrospinal fluid (CSF) tradition confirmed Mycobacterium tuberculosis. The affected person was identified with TBM and handled with isoniazid, rifampin, pyrazinamide, ethambutol and vitamin B6 for 12 months. The well timed analysis of TBM will be difficult as a result of a nonspecific medical presentation. In sufferers with a sub-acute onset of headache, fever and meningeal indicators, TBM ought to be thought of within the differential. If suspected, therapy ought to be initiated instantly to forestall additional neurological impairment and dying.
PMID: 29456899 [PubMed]