Concluded Case

HEADACHE IN A 24YRS/M WITH PTB

24yrs old male known case of PTB on ATT since 3mnths have come with C/o Persistent Headache, giddiness and vomitting since 15days.N/h/o Fever,Seizure and No travel history.O/e - Neurological intact.DIAGNOSIS AND MANAGEMENT PLAN?

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Concluded answer

OPINION OF A NEUROLOGIST - The scanning shows multiple hyperintense irregular opacities of tuberculoma and compressed posterior horns and diltation of anterior horns of lateral ventricle,indicative of increased intracranial pressure - TB meningitis. Rx - ATT needs to continue for 1 year and Rule out milliary tb elsewhere in body,GI tract, urinary tract,bones.

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Multiple small ring enhancing lesions in case of pul Koch is surely tubercles. Now the question you are seeking is , inspite of on att for 3 months pt developed cns tb. Chech for drug resistance. Check and revise for dose as per weight. Add steroids and antiepileptics if not done. Check for HIV too. Regular follow ups with opthalmic check up to look for papilledema. Also for cns tuberculosis the duration of therapy is prolonged. So revise it accordingly.

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MRI brain shows multiple tiny dense opacities all over brain Pt has c/o headache 15days giddiness and vomiting Also on ATT for PTB This is tubercular spread to brain Tubercular encephalitis

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Diffuse tiny and variable size contrast enhancing lesions,some with small ring enhancing with meningieal enhancement supratentorial ,brainstem and infratentorially. With the back ground H/o PTB most probably neuro tuberculosis. Suggest CSf study ,CSF for TB PCR. 4 drug regimen with steroid.

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Dx-Dissiminated tuberculosis to brain parenchyma. Symptoms are due to raised intracranial tension.pt may have milliary tuberculosis and haematogenous spread may be there. MRI shows multiple ring shaped small hyperintense shadows suggestive of multiiple tubeculoma brain. ATT regiem should be prolonged for 1yrs and antiepileptics steroid and mannitol should be add on with ATT.

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Multiple rings enhancement lesion with taking ATT suggestive of brain tuberculosis but it can be brain lymphoma so do HIV and csf

? ASTROCYTOMA .. ? GLIOMATOSIS .. ? CEREBRAL TUBERCULOMAS.. NEED'S.. EXPERTS OPINION

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Several small opacities present Tuberculoma , CSF exam study

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Cerebral Neurocercystic? Cerebral Tuberculosis?

cns tuberculosis.. add 4 drug att

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