Abstract Ref Number = APCP1107
TUBERCULOUS MENINGITIS AND PRE RETINAL HAEMORRHAGE
Ati Rahmipurwandari,Hadia Angriani,Amiruddin L
Departemen Ilmu Kesehatan Anak FK Universitas Hasanuddin
Background : Tuberculous meningitis is the most common TB complication of the central nervous system that affected the meningens, caused by Mycobacterium tuberculosis. 0.5-3% will spread limphohemagenously and become meningitis TB, but 1,2% had no focus infection. Incidence varies, 6.2% of extrapulmonary TB. Pre retinal haemorrhage is one of intraocular bleeding complications due to subarachnoid hemorrhage.
Case Presentation Summary : A case of tuberculous meningitis with pre retinal haemorrhage in a boy aged 7 months 28 days. Diagnosis is based on history taking: decreased consciousness and fever since 7 days after 3-5 series of seizures with duration of ± 30 minutes. Physical examination showed somnolent GCS9 (E3M4V2), subfebrile fever, malnutrition, increased muscle tones, physiological reflex, and pathological reflex (Babinski), papil oedem and pre retinal hemorrhage around the papil and macula on funduscopy, TB score 1. Laboratory findings: Wbc 12.000/mm3, Hb 9,2 gr/dL, MCV 73 ?m3, MCH 22 pg, Plt 270.000/mm3. No growth of aerobic bacteria on blood culture. Liquor analysis: xanthochrome, leucocyte 100/mm3, MN 90%, protein 100 mg/dl, LDH 112, glucose level 72 mg/dl, Nonne and Pandi negative, and Mycobacterium tuberculosis bacillus. Normal on chest X-ray. Head CT-scan shows meningoencephalitis and cerebral edema. After given with antibiotics, anti-tuberculosis drugs, steroids and mannitol the patients condition was improved.
Learning Points/Discussion : 1. Tuberculous meningitis is one of the most common TB complications with high morbidity, mortality and poor prognosis. 2. Generally results from the spread of primary TB, but 1,2% had no focus infection. 3. Intracranial pressure was the main cause of the pre retinal hemorrhage. 4. Early diagnosis and treatment TB meningitis can significantly reduce the sequelae and mortality rate.
Keywords: Tuberculous Meningitis Pre Retinal Haemorrhage Increased Intracranial Pressure