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Dr. Andrew Rynne
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Article Home Adult and Senior Health Tubercular meningitis

Tubercular meningitis

It is the tuberculosis affecting the meninges, the membranes which cover the brain. It is the common form of CNS tuberculosis. It occurs when the tuberculosis bacteria affects the membrane and fluid surrounding the brain and spinal cord.


Tubercular meningitis occurs as a result of spread of infection from other places through blood. It is more common in children under the age of 5 years. It is a life threatening disease. In the brain they form micro tubercles.

Risk factors of tubercular meningitis

It is more common in individual with

  • AIDS
  • Excessive alcohol use
  • Weakened immune system
  • Pulmonary tuberculosis

Symptoms of tubercular meningitis

  • Fever
  • Headache
  • Nausea and vomiting
  • Seizures
  • Loss of consciousness
  • Neck stiffness
  • Confusion.
  • Loss of appetite
  • Photophobia, excess of sensitivity to light

Diagnosis of tubercular meningitis

  • CSF analysis shows elevated proteins level, moderate reduction of glucose and presence of pleocytosis.
  • Lumbar puncture
  • CSF culture
  • Chest x-ray
  • CT brain.
  • Sputum AFB.
  • Biopsy of brain and meninges

Types of TB meningitis

TB meningitis is categorized in to 3 clinical stages



I (early)

Generalized weakness or malaise

2 (Intermediate)

Lethargy, meningismus, focal neurological deficits like cranial nerve palsies,

3 (Late)

Seizures, severe neurological deficits like paresis, stupor or coma.




  • Paralysis
  • Seizures
  • Cranial nerve palsies
  • Mental impairment
  • Abnormal behavior

Treatment of tubercular meningitis

TB meningitis is treated with antitubercular drugs like Rifampicin, isoniazid, Pyrizanamide, and ethambutol. These four drugs are given for 2 months followed by Rifampicin and isoniazid for 10 months. The treatment is given for one year.

Systemic corticosteroids like predinisolone and dexamethasone are used.

TB meningitis can be prevented by giving BCG vaccination to all the infants.