TUBERCULAR MENINGITIS.-
- RUDDOCK.E.H,
This disease has also been called acute hydrocephalus, or water on the brain. It is much more common in children than in adults. In the latter it is usually a sequel to marked Tuberculosis elsewhere; in children it may be the first obvious sign of tubercle, although the actual source of meningeal infection in these cases, is virtually always elsewhere in the body, e.g., a causating gland infecting the blood stream, or tuberculosis of bone, middle ear, etc.
It may occur in the first year of life, but the most common time of attack is from the second to the fifth year. The membranes at the base of the brain are usually those most affected. Pus is exuded, tubercules are present and the lateral ventricles are dilated and full of a turbid fluid. Some encephalitis usual.
SYMPTOMS.- Premonitory symptoms are common, restlessness, loss of appetite, peevishness and loss of flesh. Measles or whooping cough may be precedent conditions. The actual disease generally sets in suddenly with a convulsion, or with violent headache, vomiting and fever. The pain is intense and the short, sudden cry which it causes the child to utter is characteristic. Vomiting is independent of food-taking. Constipation is the rule. The fever rises gradually to 102 degree or 103 degree. The pulse, at first quick, becomes irregular and slow; muscles twitch and the pupils are generally contracted.
After a day or two this stage of irritation give way to one of dullness and apathy with periods of delirium. The abdomen is retracted and the constipation obstinate. The head is drawn back and the neck rigid. Squint is common and the pupils now dilate. This stage deepens into coma with convulsions, relaxed sphincters and a final typhoid state. The temperature tends to be subnormal, but may rise very high just before death. The pulse quickens again at this period of the disease. Optic neuritis is often present. The whole duration of the disease may be from two three weeks, but in adults when meningitis is a terminal lesion, and occasionally in children, it is very rapid and kills in a few days.
DIAGNOSIS.- Typical cases are fairly easy to diagnose. Lumbar puncture by an expert drawn off the cerebrospinal fluid and in it tubercle bacilli may be found. Tubercular disease elsewhere naturally helps to the realization of the condition.
TREATMENT.- Very few cases of Tubercular meningitis recover and treatment is correspondingly hopeless. In the early stages Calcarea is the most hopeful remedy, especially in fat, chilly children with poor digestion. Bryonia may help the symptoms of onset. Iodoform and Oxalic Acid are both to be considered in the second stage, and Hellebore particularly when effusion may be held to have taken place into the ventricles. Tuberculin in relatively low potencies (Tub. Bov. 6 to 30) has now and then seemed to help.
It is usual to apply ice to the head, but very often hot applications, will be found much more soothing to the delirium and convulsions, and Belladonna or Hyoscyamus may control these symptoms, though neither will cure the disease. Light diet, mostly fluid, should be given and in the rare event of the disease taking a favourable turn, great care is essential during convalescence.
This disease has also been called acute hydrocephalus, or water on the brain. It is much more common in children than in adults. In the latter it is usually a sequel to marked Tuberculosis elsewhere; in children it may be the first obvious sign of tubercle, although the actual source of meningeal infection in these cases, is virtually always elsewhere in the body, e.g., a causating gland infecting the blood stream, or tuberculosis of bone, middle ear, etc.
It may occur in the first year of life, but the most common time of attack is from the second to the fifth year. The membranes at the base of the brain are usually those most affected. Pus is exuded, tubercules are present and the lateral ventricles are dilated and full of a turbid fluid. Some encephalitis usual.
SYMPTOMS.- Premonitory symptoms are common, restlessness, loss of appetite, peevishness and loss of flesh. Measles or whooping cough may be precedent conditions. The actual disease generally sets in suddenly with a convulsion, or with violent headache, vomiting and fever. The pain is intense and the short, sudden cry which it causes the child to utter is characteristic. Vomiting is independent of food-taking. Constipation is the rule. The fever rises gradually to 102 degree or 103 degree. The pulse, at first quick, becomes irregular and slow; muscles twitch and the pupils are generally contracted.
After a day or two this stage of irritation give way to one of dullness and apathy with periods of delirium. The abdomen is retracted and the constipation obstinate. The head is drawn back and the neck rigid. Squint is common and the pupils now dilate. This stage deepens into coma with convulsions, relaxed sphincters and a final typhoid state. The temperature tends to be subnormal, but may rise very high just before death. The pulse quickens again at this period of the disease. Optic neuritis is often present. The whole duration of the disease may be from two three weeks, but in adults when meningitis is a terminal lesion, and occasionally in children, it is very rapid and kills in a few days.
DIAGNOSIS.- Typical cases are fairly easy to diagnose. Lumbar puncture by an expert drawn off the cerebrospinal fluid and in it tubercle bacilli may be found. Tubercular disease elsewhere naturally helps to the realization of the condition.
TREATMENT.- Very few cases of Tubercular meningitis recover and treatment is correspondingly hopeless. In the early stages Calcarea is the most hopeful remedy, especially in fat, chilly children with poor digestion. Bryonia may help the symptoms of onset. Iodoform and Oxalic Acid are both to be considered in the second stage, and Hellebore particularly when effusion may be held to have taken place into the ventricles. Tuberculin in relatively low potencies (Tub. Bov. 6 to 30) has now and then seemed to help.
It is usual to apply ice to the head, but very often hot applications, will be found much more soothing to the delirium and convulsions, and Belladonna or Hyoscyamus may control these symptoms, though neither will cure the disease. Light diet, mostly fluid, should be given and in the rare event of the disease taking a favourable turn, great care is essential during convalescence.
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