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Computed tomography of tuberculous meningitis in infants and children
Abstract:
Three cases are used to illustrate the computed tomography (CT) findings of tuberculous meningitis in infants and children. The clinical and laboratory findings of these patients are presented, and the differential diagnosis of viral, bacterial and fungal meningitis is reviewed. Tuberculous meningitis should be suspected, even in the infant or child with a negative tuberculin skin test, when a chronically ill patient presents with the acute signs of meningismus, the cerebrospinal fluid analysis demonstrates a low glucose and monocytosis, and cranial CT shows ventricular enlargement with prominent basal and sylvian fissure enhancement after intravenous contrast medium injection. The ease and safety of serial CT examinations make this procedure the ideal radiological method to follow the patient's course in order to evaluate the response to treatment.
Insights
Computed tomography (CT) effectively identifies tuberculous meningitis in children, even with negative skin tests. Serial CT scans help monitor treatment response in this serious infection.
Area of Science:
- Pediatric Neurology
- Infectious Diseases
- Radiology
Background:
- Tuberculous meningitis (TBM) is a severe infection requiring early diagnosis.
- Distinguishing TBM from other forms of meningitis (viral, bacterial, fungal) can be challenging.
- Computed tomography (CT) plays a crucial role in diagnosing central nervous system infections.
Observation:
- Presents three pediatric cases illustrating CT findings in tuberculous meningitis.
- Highlights clinical and laboratory features aiding TBM diagnosis.
- Reviews differential diagnoses for meningitis in infants and children.
Findings:
- Tuberculous meningitis should be suspected in chronically ill children with meningismus, low cerebrospinal fluid glucose, and monocytosis.
- Cranial CT reveals characteristic findings: ventricular enlargement and enhancement in basal and sylvian fissures post-contrast.
- A negative tuberculin skin test does not exclude TBM.
Implications:
- CT imaging is vital for diagnosing TBM in pediatric patients.
- Serial CT examinations are safe and effective for monitoring treatment response.
- Early CT diagnosis can lead to timely intervention and improved outcomes for TBM.