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CASE REPORT
Year : 2013  |  Volume : 3  |  Issue : 4  |  Page : 388-391

A case of tuberculous meningitis presenting with cognitive defects


Department of Medicine, J. L. N, Medical College, Ajmer, Rajasthan, India

Correspondence Address:
B H Shankaragouda
Room No. 211, Resident Doctors Hostel, JLN Medical College, Ajmer - 305 001, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2231-0738.119856

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Tuberculosis (TB) affects one-third of the world's population and is the leading cause of human mortality and morbidity. Treating TB is the most efficient and cost-effective of all health interventions. A 22-year-old male patient presented with loss of appetite, on and off fever since a month, and past 4 days patient was irritable and in altered sensorium. There was no history of headache, nausea, and vomiting or neck pain. On examination he had signs of meningeal irritation with palsy of right sixth cranial nerve, resting tremors in hands, generalized rigidity and cognitive defects like apathy, psychomotor retardation, and impaired memory. Investigations revealed elevated ESR; Chest X-ray showed bilateral milliary shadows and MRI brain showed mildly dilated ventricles and hyperintense lesions. Patient was started on oral anti-tubercular treatment under category I intensive phase, parenteral dexamethasone and mannitol and patient made remarkable clinical improvement and was discharged after 2 weeks. Atypical presentation of TBM is not uncommon in developing nations like India. We report one such case presenting with unusual symptoms and signs. This report is intended to make physicians aware of the unusual clinical presentations of tuberculous meningitis.


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