Tuberculous meningitis and hydrocephalus.

CMYK 155 Although there are a large number of publications available in the literature recommending the benefits of a shunt procedure in tuberculous meningitis, the subject deserves a more comprehensive analysis. Hydrocephalus frequently accompanies tuberculous meningitis. Mild to severe hydrocephalus is almost always identified on computer based imaging in cases with tuberculous meningitis and occurs early in the pathological events. Despite this fact, all cases of tuberculous meningitis associated with hydrocephalus are not suitable for a shunt operation. The exact pathogenesis of hydrocephalus in tuberculous meningitis is unclear. The hydrocephalus is probably a result of basal adhesive meningeal reaction wherein the flow of the CSF is obliterated in its course from the point of exit from the fourth ventricle to the site of its absorption in the arachnoid villi. Obliteration of the arachnoid villi themselves and various other speculations have been proposed as to the cause of the hydrocephalus in tuberculous meningitis. Like in tuberculosis elsewhere in the body, in tuberculous infection of the brain, basal arachnoiditis and arteritis suggests presence of an aggressive disease and the presence of tuberculomas suggests an aggressive body response and a relatively favorable outcome. Basal arachnoiditis can be mild to very extensive in tuberculous meningitis. The tuberculous exudates result in gumming up of the subarachnoid spaces. Visual deficit is in general a result of affection of the optic nerve and its membranes. Optic atrophy and visual deficits, occur relatively early in the clinical course and suggests the severity of the disease. Hemispheric convexity arachnoiditis result in cortical irritation and can cause focal convulsions. Apart from adhesive basal arachnoiditis the other important pathological event that occurs is basal arteritis. Small or large vessel arteritis is the principle crippling factor in the neurological squeal of tuberculous meningitis. Worsening sensorium from drowsiness to unconsciousEditorial