Dr. Hitesh Kumar
Neurology
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Patient's Query
Hi doctor,
The patient is a 28 year old male. His weight is 123.46 lb 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 intensive care unit (ICU) in the hospital and got discharged after 10 days. He had an magnetic resonance imaging (MRI) brain with contrast after one day of my admission and it suggested chronic infective granulomas with leptomeningeal involvement. The other tests were cerebrospinal fluid (CSF) GeneXpert negative, CSF adenosine deaminase (ADA) negative. TB medication - anti tuberculosis drugs (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. Magnetic resonance imaging (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 tuberculosis bacteria (TB) bacteria. Mild bearable headaches can be also associated with secondary depression, which many patients develop with any chronic illness. The investigations to be done are 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 include- 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).
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