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Tuberculous meningitis presenting with nonconvulsive status epilepticus.
Fehim Arman1, Dilaver Kaya, Yasemin Akgün
1Department of Neurology, Acibadem University School of Medicine, Istanbul, Turkey. fehimarman@yahoo.com
Epilepsy & Behavior : E&B
|December 7, 2010
Summary
Nonconvulsive status epilepticus (NCSE) can be caused by tuberculous meningitis (TBM). Early diagnosis and treatment of TBM are crucial for managing NCSE and improving patient outcomes.
Area of Science:
- Neurology
- Infectious Diseases
- Critical Care Medicine
Background:
- Nonconvulsive status epilepticus (NCSE) presents with altered consciousness and continuous EEG ictal discharges, often with diverse etiologies.
- Tuberculous meningitis (TBM) is a severe central nervous system infection with varied clinical manifestations and diagnostic challenges.
Observation:
- A 66-year-old woman presented with altered mental status, diagnosed with NCSE.
- Diagnostic workup revealed TBM, evidenced by elevated cerebrospinal fluid protein and positive molecular/immunological assays for tuberculosis.
Findings:
- The patient received a four-drug anti-tuberculosis regimen as per the status epilepticus protocol.
- She demonstrated a positive clinical response to the anti-tuberculosis treatment.
Implications:
- This case highlights TBM as a potential, albeit uncommon, cause of NCSE.
- Clinicians should consider TBM in the differential diagnosis of NCSE, especially in endemic areas or in patients with risk factors.
- Prompt recognition and management of TBM are essential for resolving NCSE and preventing neurological sequelae.
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