30yrs old female admitted with C/o fever with chills and headache since two months and altered sensorium of one day duration with difficulty in breathing.clinically obtunded,cold clammy. significant findings are CNS - Drowsy,Pupils - B/l 5mm SRTL,GCS - E3V1M6,Kernigs and brudzinski signs positive,B/l Plantar flexor.Power - 3/5 in all four limbs.Vitals stable.CT,MRI brain and CSF report enclosed.

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It's a TBM ...MRI S/o hydrocephalus also ...kindly do fundus examination ...if papilloedema...then plan for ventriculostomy..for omaya reservoir placement ...as csf protein is raised shunt is not an option rt now ...regular tap from omaya to be done .once csf values are appropriate then plan for shunt if hydrocephalus persist .. regularly csf tap and ATT .. STEROID .. IMPROVE THE CONDITION AND SHUNT NOT TO BE needed ...
Thank u sir.
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TBM c obstructive Hydrocephalus. Management:Inj Mannitol,IV drip,Inj Phenytoin,ATT Inj Streptomycin Rifampicin, Pyrazinamide Ethumbutol,Inj Methylprednisolone,PPI,Inj MVI,Moist O2, Nebulization,Inj Pipercilin Tazobactum, Ryles feeding if necessary.Monitor PRT & Vitals,LFT,RFT,CPK,LDH,Na+,K+,Hco3-,ECG.Refer to Neurosurgeon for opinion & management for Shunt & accordingly
Thanks Dr Prashant Vedwan
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History of Fever since 1 month with development of Altered Sensorium and presence of Hydrocephalus on MRI CSF picture of increased protein s/o Chronic Etiology like TBM.... But also rule out Chronic meningitis...
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TBM,ATT.,MANNITOL, antipyretic, corticosteroid inj, iv fluids to maintain electrolyte balance n nutrition.Bronchodilator for breathlessness. .
However the protocol starts with Broad spectrum Antibiotics including Vancomycin plus ATT including Steroid
Tuberculosis meningitis Management as suggested by Dr.Padam Chand
Thanks ! Dr.Prashant Vedwan
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TBM Anti Koch’s Corticosteroids can be added
Tuberculosis meningitis
TBM with hydrocephaius
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