Patan Academy of Health Sciences, Lagankhel, Lalitpur, Nepal.
Intensive Care Unit, Nidhan Hospital, Pulchowk, Lalitpur, Nepal.
JNMA J Nepal Med Assoc. 2022 Jul 1;60(251):654-656. doi: 10.31729/jnma.7588.
Tubercular meningitis is a devastating presentation of extra pulmonary tuberculosis, with fatality in each case without treatment. A 39 years male, a regular consumer of alcohol and a known case of major depressive disorder, presented with the alleged history of using an electric heater in a closed room, and presented to emergency with unconsciousness and cardiac arrest. As his neurological status didn't improve over 72 hrs, a magnetic resonance imaging brain was done which was non-conclusive. Electroencephalogram revealed diffuse right fronto-parietal seizure activity ceasing with midazolam injection, hence levetiracetam was started. Lumbar puncture revealed increased adenosine deaminase and nil white blood cells. Repeat lumbar puncture showed lymphocytic-predominant pleocytosis, elevated protein and low glucose. The patient was started on anti-tubercular therapy and an injection of dexamethasone was added. Repeat electroencephalogram didn't show any seizure-like activity. It is important to be aware of variety of presentations of tubercular meningitis. Delay in treatment leads to irreversible neurological damage and even death.
cardiac arrest; case report; tubercular meningitis; unconsciousness.
结核性脑膜炎是肺外结核的一种毁灭性表现，如果不治疗，每一例都会导致死亡。
一名 39 岁男性，经常饮酒，且患有重度抑郁症。他被指控在封闭的房间内使用电暖气，随后出现了无意识和心脏骤停，并被送往急诊。由于他的神经状态在 72 小时内没有改善，因此进行了脑部磁共振成像检查，但结果并不明确。脑电图显示弥漫性右额顶叶癫痫样放电活动，随着咪达唑仑的注射而停止，因此开始使用左乙拉西坦。腰椎穿刺显示腺苷脱氨酶升高，白细胞数正常。重复腰椎穿刺显示以淋巴细胞为主的白细胞增多、蛋白升高和血糖降低。患者开始接受抗结核治疗，并加用地塞米松注射。重复脑电图未显示任何癫痫样活动。
结核性脑膜炎有多种表现形式。治疗的延迟会导致不可逆转的神经损伤，甚至死亡。
心脏骤停；病例报告；结核性脑膜炎；意识丧失。
