Dr. Hitesh Kumar
Neurology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
My father was suffering from fever and right sided headaches, which felt like an electric shock. So, we consulted a doctor, and after several tests, the doctor diagnosed it as tubercular meningitis. All the test including computed tomography (CT) scan were normal. So, he prescribed Forecox, Benadon, and Urimax D for urine issues. Then after 20 to 25 days, the fever and headaches came down. But now, he has headaches only in the evenings, that feel like an electrical shock. So, this time the doctor gave him Sibelium 10 mg and Lonazep 0.5 mg. He still has these headaches, but they are not continuous. Please help.
Hello,
Welcome to icliniq.com. I would like to know few more details. 1. Since when is he on tuberculosis medicines? 2. Since when is he having fever and headaches? 3. How long does one episode of the headache last? 4. Does he have any nausea or vomiting during the headache? 5. Does this headache increase on lying down? 6. How frequent are these headaches? Along with these details, I would like to see all the reports including CT (computed tomography), MRI (magnetic resonance imaging), and CSF (cerebrospinal fluid) tests. Investigations to be done are. 1. CT head, to rule out hydrocephalus. 1. Fundus examination, to check intraocular pressure and fundus.
Patient's Query
Thank you doctor,
He started medications for tuberculosis two months back. He is having fever and headaches from past three months. After taking the medicines, his fever has come down, but he still has the electrical shock feeling in the evenings. He sleeps properly at night, and he does not have nausea or vomiting. The pain does not increase on lying down. The headaches appear mostly in the evenings, in the mornings it is very less. But, he is very weak, probably because of the medications. His sodium and potassium were less initially, but now they are normal. His liver function test (LFT) was also normal. I have uploaded the computed tomography (CT) scan file, kindly check and suggest.
Hello,
Welcome back to icliniq.com. His CT head report is normal (attachment removed to protect patient identity). But, it was done three months back. Was CSF (cerebrospinal fluid) also tested that time? If yes, then please attach that and the hospital discharge summary also. Some patients with tuberculous meningitis may develop hydrocephalus (enlargement of ventricles in the brain), and that can lead to headaches and blurring of vision. Or it can be some dural collection or tuberculomas. I suggest you get a new magnetic resonance imaging (MRI) of the brain.
Patient's Query
Hello doctor,
Thank you for replying. Cerebrospinal fluid (CSF) was not tested at the time. I have uploaded the discharge summary, please suggest some medicines.
Hello,
Welcome back to icliniq.com. As per the discharge summary (attachment removed to protect patient identity), your doctor has started ATT (antitubercular treatment) empirically. There had been some findings in the abdomen and chest also. Possibly he wanted to rule out the possibility of some tumor in the body, which can cause similar findings. If after starting of ATT, the fever has come down, that favors the possibility of tuberculosis. Has there been any weight loss, cough, or expectoration? I suggest to continue ATT and get the following investigations done. 1. MRI brain with contrast. 2. Cerebrospinal fluid (CSF) examination. Protein, sugar, cell count, Gram stain, AFB (acid-fast bacilli), TB PCR (tuberculosis polymerase chain reaction), ADA (adenosine deaminase), malignant cells, India ink stain, cryptococcal antigen, KOH (potassium hydroxide) stain. 3. Full body PET (positron emission tomography) scan.
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Neurology
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