Publication: Loss of Consciousness and Cardiac Arrest as an Atypical Presentation of Tubercular Meningitis: A Case Report
Date
2022
Journal Title
Journal ISSN
Volume Title
Publisher
Nepal Medical Association
Abstract
Abstract
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.
Description
Saroj Yadav
Patan Academy of Health Sciences, Lagankhel, Lalitpur, Nepal
Santosh Acharya
Intensive Care Unit, Nidhan Hospital, Pulchowk, Lalitpur, Nepal
Astha Thapa
Patan Academy of Health Sciences, Lagankhel, Lalitpur, Nepal
Aditya Hirday
Patan Academy of Health Sciences, Lagankhel, Lalitpur, Nepal
Agnimshwor Dahal
Patan Academy of Health Sciences, Lagankhel, Lalitpur, Nepal
Keywords
Cardiac arrest, Case report, Tubercular meningitis, Unconsciousness.