Concluded Case

10yrs/F with headache and vomitting

10yrs old female child with history of headache n vomitting since 1 months,Fever along with Fits × 3days DIAGNOSIS AND APPROACH?

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Ct brain plain and contrast available.plainct showsventriculomegaly lateral abs 3rd ventricles with mild periventricular hypodensity.Contrsat shows diffuse meningeal enhancement with gyral enhancement both parietotemporal, enhancement in thequadrigeminal cisterns & tentorium cerebelli. Imp: The CT picture is suggestive of chronic meningitis.Duration of symptoms also 1 month .GYRAL enhancement suggestive of encephalone involvement and that is the reason for seizures. Commonest this age is Neurotuberculosis.Suggest CSF study.Exclude vasculitis . Emperically start on ATT 4 drug regimen with steroid in view of the basal enhancement.

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Ct brain plain and contrast available.plainct showsventriculomegaly lateral abs 3rd ventricles with mild periventricular hypodensity.Contrsat shows diffuse meningeal enhancement with gyral enhancement both parietotemporal, enhancement in thequadrigeminal cisterns & tentorium cerebelli. Imp: The CT picture is suggestive of chronic meningitis.Duration of symptoms also 1 month .GYRAL enhancement suggestive of encephalone involvement and that is the reason for seizures. Commonest this age is Neurotuberculosis.Suggest CSF study.Exclude vasculitis . Emperically start on ATT 4 drug regimen with steroid in view of the basal enhancement.

As history is of 1 month duration with headache and vomiting due to raised intracranial pressure- Tubercular meningitis with secondary Communicating hydrocephalus is the most likely Diagnosis. As there are fits and fever since 3 days - associated secondary pyogenic meningitis may have occurred Management- 1.C.SF analysis will confirm the diagnosis of Tubercular meningitis and associated pyogenic component if any 2.Start with steroids Inj phenytoin Inj cetriaxone Slow IV fluids If CSF report is in favour of Tubercular meningitis- ATT to be started. Invariably patient will need a ventriculo - peritoneal shunt .

Chronic meningitis with communicating hydrocephalus with periventricular oozing Considering 1 month history high probability of tubercular meningitis ATT should be started empirically with steroid CSF analysis can be done under caution with guarded csf tapping technique under cerebral decongestant If patient not improving or further deteriorating shunt can be planned

Valuable opinion
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These are CT images of Brain , first without contrast and second with contrast There is generalised ventriculomegaly and post contrast enhancement of pachymeninges which is suggestive of obstructive hydrocephalus caused by meningitis Adv Fundoscopy followed by Lumbar puncture with analysis of CSF

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Obstructive hydrocephalus at 4th ventricle level . ? TB meningitis Neurosurgeon opinion

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Acute basal meningitis with hydrocephalus

Hydrocephalus?? Obstructive??? Possible Tubercular

Meningitis with hydrocephalus. Need . CSF. MT ? TBM.

MENINGITIS WITH HYDROCEPHALUS. NEED CSF. MT ? TBM PLAN SHUNT.

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