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1、TuberculousMeningitisCHCUMSDIVISIONOFINFECTIOUSDISEASEANDGASTROENTEROLOGYNovember24th,20041EPIDEMIOLOGY-TBMTuberculousMeningitis(TBM)Theyoungerthechildren,themorereadilytodevelopTBM.60%inChildrenaged1-3yearsDeathrate:15-30%2TBM(Tuberculousmeningitis)TBMisthemostseriouscomplicationoftuberc
2、ulosisinchildrenandisusuallyfatalwithouttreatment.TBMalwaysbeapartofsystemicdisseminatedtuberculosis.TBMoftenoccurswithin1yearofinitialinfection,especiallyinthefirst2to6monthsofinfection.3TuberculousBacilliPrimaryComplexBacteremiaRichFociSubarachnoidSpaceBrainorSpinalCordPerenchymaTubercu
3、lomasMeningitisPATHOPHYSIOLOGYTrauma/Diseasesmeasles,pertussisMiliaryTB4PATHOLOGICALEFFECTSMeningesDiffuseHyperemiaEdemaInflammatoryExudatesConformationofTubercles5PATHOLOGICALEFFECTSSubarachnoidSpaceAlargeamountofthickgelatinousexudatesconcentratetothepavimentumcerebri,opticchiasma,bridg
4、eofvarolius,bulbusrhachidicusandSylvianfissure.BasalmeningitisaccountsforthefrequentdysfunctionofcranialnervesIII,VI,andVII.6PATHOLOGICALEFFECTSCerebralParenchymaTuberculousmeningoencephalitisswellingandhyperemiaoftheparenchymacontributetotheintracranialhypertension,thenischemiaofparenchy
5、maoccur,finallyleadtothefociofencephalomalaciaandnecrosis.Hemiplegiamaybepresentbecauseofthischange.Meninges,spinal,andspinalnerverootalsoinvolvement.Thelateralwaysleadstoparaplegina.7PATHOLOGICALEFFECTSCerebralVesselsThebacteriainvadetheadventitiadirectlyintheearlystageandinitiatetheproc
6、essofacutevasculitis.Progressivedestructionofadventitia,disruptionofelasticfibers,andfinallyintimaldestruction(endoarteritis),leadtotheobliterativevasculitis,whichmayfacilitatetheischemia,encephalomalaciaandnecrosisofparenchyma.8CirculationofCSFChoroidplexusLateralventricleInterventricula
7、rforamenthe3rdventricleCerebralaqueduct4thventricle2Lateralforamina1MedialforamenSubarachnoidspaceArachnoidgranulationsDuralsinusVenousdrainage9PATHOLOGICALEFFECTSHydrocephalusHyperemiaofchoroidsoverproductionofCSFInflammatoryadherenceofMeningedefectiveabsorptionofC