Abstract
Tuberculous meningitis (TM) is associated with high morbidity and mortality. The early diagnosis
and treatment of tuberculous meningitis saves lives. Diagnosis is based on clinical features, cerebrospinal
fluid changes, and imaging characteristics. The clinical features of TB meningitis sometimes are initially
non-specific, although clinical meningitis with cranial neuropathies, cerebral arteritis, hydrocephalus and
spinal arachnoiditis are well recognized by most physicians. Bacteriological confirmation, such as microscopy
for acid-alcohol-fast bacilli, polymerase chain reaction and culture, is not possible in all cases as
those tests do not have sufficient sensitivity; however, this depends on the volume of CSF examined.
Brain imaging should be performed if the patient deteriorates. The complications of hydrocephalus, infarction,
and tuberculoma are common complications of tuberculous meningitis and a neurosurgical opinion
should be sought in those who are failing medical therapy. Early treatment with four drugs (isoniacid,
rifampicin, pirazinamide and etambutol) prevents death or disability. Adjunctive treatment with corticosteroids
improves survival but probably does not prevent severe disability.
