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1、TuberculousMeningitisCHCUMSDIVISIONOFINFECTIOUSDISEASEANDGASTROENTEROLOGYNovember24th,20041EPIDEMIOLOGY-TBMTuberculousMeningitis(TBM)Theyoungerthechildren,themorereadilytodevelopTBM.60%inChildrenaged1-3yearsDeathrate:15-30%2TBM(Tuberculousmeningitis)TBMisthemostseriouscomplicati
2、onoftuberculosisinchildrenandisusuallyfatalwithouttreatment.TBMalwaysbeapartofsystemicdisseminatedtuberculosis.TBMoftenoccurswithin1yearofinitialinfection,especiallyinthefirst2to6monthsofinfection.3TuberculousBacilliPrimaryComplexBacteremiaRichFociSubarachnoidSpaceBrainorSpinalC
3、ordPerenchymaTuberculomasMeningitisPATHOPHYSIOLOGYTrauma/Diseasesmeasles,pertussisMiliaryTB4PATHOLOGICALEFFECTSMeningesDiffuseHyperemiaEdemaInflammatoryExudatesConformationofTubercles5PATHOLOGICALEFFECTSSubarachnoidSpaceAlargeamountofthickgelatinousexudatesconcentratetothepavime
4、ntumcerebri,opticchiasma,bridgeofvarolius,bulbusrhachidicusandSylvianfissure.BasalmeningitisaccountsforthefrequentdysfunctionofcranialnervesIII,VI,andVII.6PATHOLOGICALEFFECTSCerebralParenchymaTuberculousmeningoencephalitisswellingandhyperemiaoftheparenchymacontributetotheintracr
5、anialhypertension,thenischemiaofparenchymaoccur,finallyleadtothefociofencephalomalaciaandnecrosis.Hemiplegiamaybepresentbecauseofthischange.Meninges,spinal,andspinalnerverootalsoinvolvement.Thelateralwaysleadstoparaplegina.7PATHOLOGICALEFFECTSCerebralVesselsThebacteriainvadethea
6、dventitiadirectlyintheearlystageandinitiatetheprocessofacutevasculitis.Progressivedestructionofadventitia,disruptionofelasticfibers,andfinallyintimaldestruction(endoarteritis),leadtotheobliterativevasculitis,whichmayfacilitatetheischemia,encephalomalaciaandnecrosisofparenchyma.8
7、CirculationofCSFChoroidplexusLateralventricleInterventricularforamenthe3rdventricleCerebralaqueduct4thventricle2Lateralforamina1MedialforamenSubarachnoidspaceArachnoidgranulationsDuralsinusVenousdrainage9PATHOLOGICALEFFECTSHydrocephalusHyperemiaofchoroidsoverproductionofCSFInfla
8、mmatoryadherenceofMeningedefectiveabsorptionofC
