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Q. What to do for headache in case of chronic infective granulomas?

Answered by
Dr. Hitesh Kumar
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Dec 20, 2016 and last reviewed on: Feb 03, 2021

Hi doctor,

The patient is a 28 year old male. His weight is 56 kg and height is 6 feet. He was an assistant Professor in an Engineering college. For around five days, He had a heavy unbearable headache, high fever, vomiting, loss of appetite, lost consciousness and had a single episode of seizure on the fifth day. He was admitted to ICU in the hospital and got discharged after 10 days. He had an MRI brain with contrast after one day of my admission and it suggested chronic infective granulomas with leptomeningeal involvement. The other tests were CSF GeneXpert negative, CSF ADA negative. TB medication - AKT 4 was started along with tablet Levipil 500, tablet Benadon 40, tablet Pan 40 and tablet Wysolone (40, 30, 20, 10 and 5 mg dose reduction). His current symptoms are frequent, bearable headache every day, Headache may continue for an hour. It is nearly one month and still I have a headache, but the amplitude of headache is less than that of during and before hospitalization. Please give us suggestion for follow up.

#

Hello,

Welcome to icliniq.com.

  • As per given history and reports, it seems that the patient had meningoencephalitis. The probable cause for which may be tuberculosis.
  • MRI also showed granulomas in the brain and the patient is currently on four drug ATT (antituberculosis treatment) with oral steroids.
  • As the patient is having mild headaches for the last one month, there is a need to consider possibilities of hydrocephalus (enlargement of ventricles in the brain) and tuberculosis bacteria being resistant to ATT. Favorable thing is that GeneXpert is negative, so less chance of being resistant TB bacteria.
  • Mild bearable headaches can be also associated with secondary depression, which many patients develop with any chronic illness.

Investigations to be done:

1. Repeat MRI brain with contrast to look for any hydrocephalus, status of granulomas - improving or newer developing.
2. Fundus examination to look for any papilledema.
3. Regular LFT (liver function test) checkup to look for any hepatotoxicity developing due to ATT.

Treatment plan:

If repeat MRI shows worsening of granulomas, then the patient can be considered to start on fifth ATT - Injection Streptomycin or tablet Levofloxacin (only after consulting neurologist).

Regarding follow up:

Revert back with the reports to a neurologist online.---> https://www.icliniq.com/ask-a-doctor-online/neurologist


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