![]() ![]() He responded well to the treatment and was discharged on the 23rd day of care with good condition and no sequele of neurologic deficit. Lumbar Puncture was contra-indicated because he had papilledema on Ophthalmoscopy examination (resulted from Hydrocephalus). We also consulted the patient to pulmonology department and they establised the Diagnosis of Lung Tuberculosis. We consulted the patient to neurosurgery department for ventriculo-peritoneal (VP) shunt procedure but his family refused it. ![]() We also treated the patient with Intravenous Dexamethasone 10mg (initial dose) continue with 5mg/ 6 hours for two weeks (we did tappered off per three days). The patient was treated with Four-drug fixed Dose Combinations (4FDC) (Tuberculous regimen consists of Isoniazid 75 mg, Rifampicin 150 mg, Pyrazinamide 400 mg, and Ethambutol 275 mg) as much as 4 tablets/24 hours/oralwith additional Isonoazid 100 mg/24 hours/oral, Streptomycin 1000 mg/24 hours/intramuscular for two months followed by Isoniazid 400 mg/24 hours/oral and Rifampicine 600 mg/24hours/oral for 10 months. A non contrast thoracic CT-Scan showed old and active lung tuberculosis with wide lesion (Data was not shown). A chest X-Ray examination showed old and active lung tuberculosis with wide lesion and left pleural reaction A contrast head CT-Scan examination showed basal enhancing exudate Axial head CT-scans of both non-contrast and contrast to the administration of intravenous gadolinium (Gd-DOTA) were performed and showed left thalamus infarct that was not enhanced by contrast injection and hypertensive hydrocephalus (obstuctive) Routine and chemistry blood examination demonstrated White Blood Cell (WBC): 13.940/mm3 Red Blood Cell (RBC): 4.55x106/mm3 Hemoglobin (Hb): 13.3g/dl Haematocrit (HCT): 38.1% Platelet (PLT): 323x103/mm3 Blood Random Glucose: 90 mg/dl Ureum 18 mg/dl Creatinine: 0.52 mg/dl SGOT: 40 mg/dl SGPT: 79 mg/dl Sodium: 126 mmol/L Potassium: 4,1 mmol/L Chloride: 90 mmol/L HIV Rapid Test non reactive HIV Antigen 0.03 (non reactive) and HIV Antibody 0.04 (non reactive). Movement and strength were unclear lateralization at first, but then we found that there was decreased movement and strenght at the right side of the body, tone and physiological reflexes were normal. Nuchal rigidity and Kernig’s sign were positive. Based on physical and neurological examination, he was sub-febrile (his temperature was 37.5oC) with Glasgow Coma Scale (GCS) score total of 11(E3M5V3). Family history of chronic cough or tuberculosis treatment was denied. There was no history of head trauma, hypertension, diabetes, high blood cholesterol level, stroke and heart disease. He had chronic cough since two months ago. He was often confused, had abnormal personal behaviour, and had double vision since two months ago.He often had fever, night sweat, and weight losssince two months ago. There were frequent nausea and vomiting for the last two months (approximately four times daily). He had headache since two months ago but became worse since two weeks ago. ![]() Int J Case Rep Images 2018 9:100905Z01AB2018.Ī 28-year-old man who was hospitalized with decreased consciousness.Consciousness decreased slowly since one week before being admitted to our hospital. Classic Tuberculous Meningoencephalitis manifestations, without lumbar puncture. īintang AK, Santoso TA, Amran MY, Akbar M. PerintisKemerdekaan KM 11, Makassar, 90245, IndonesiaĪccess full text article on other devices Wahidin, Sudirohusodo General Hospital, and Hasanuddin University Teaching Hospital, MD, PhD, Neurologist, Lecturer and Clinical Assistant Professor,ĭepartment of Neurology, Medical Faculty of Hasanuddin University,ĭr. PerintisKemerdekaanKM 11, Makassar, South Sulawesi WahidinSudirohusodo General Hospital, and Hasanuddin University Teaching Hospital, Jl. PerintisKemerdekaanKM 11, Makassar, South SulawesiĤChief of Department, Department of Neurology, Medical Faculty of Hasanuddin University, Dr. PerintisKemerdekaanKM 11, Makassar, South SulawesiģClinical Assistant Professor and Lecturer, Department of Neurology, Medical Faculty of Hasanuddin University, Dr. PerintisKemerdekaan KM 11, Makassar, South SulawesiĢClinical Fellow, Department of Neurology, Medical Faculty of Hasanuddin University, Dr. Classic Tuberculous Meningoencephalitis manifestations, without lumbar punctureĪndi Kurnia Bintang 1, Tio Andrew Santoso 2, Muhammad Yunus Amran 3, Muhammad Akbar 4ġClinical Associate Professor and Lecturer, Department of Neurology, Medical Faculty of Hasanuddin University, Dr. ![]()
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