{"presentation":{"slides":[{"elements":[{"x":4.3544662309368185,"y":8.656177105831533,"width":35.947712418300654,"height":8.639308855291576,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"

Approach to diagnosis <\/strong><\/span><\/p>\n"},"subContentId":"0aa95d1d-67cd-4edc-af1c-6891643b22d7","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":5.442363834422658,"y":15.160971922246222,"width":56.64488017429194,"height":79.91360691144709,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"

\n\t
\n\t
Clinical assessment <\/span><\/strong> <\/p>\n\t<\/li>\n\t
\n\t
CSF analysis <\/strong><\/span>
\n\ta) Cytology; Biochemical
\n\tb) Microbiological: AFB staining, Molecular \u2013 CBNAAT, CSF culture (MGIT > LJ, MGIT to be preferred) &<\/p>\n\t<\/li>\n\t
Imaging <\/strong><\/span>
\n\ta) CNS imaging: NCCT\/CECT (preferred modality), MRI (desirable)
\n\tb) Imaging to evaluate for dissemination \u2013 Chest X ray, USG abdomen<\/li>\n\t
\n\t
Other Investigations \u2013 <\/strong><\/span>
\n\ta) CSF Cryptococcal Antigen & India ink, Malignant cytology<\/p>\n\t<\/li>\n<\/ul>\n"},"subContentId":"09352e6d-423d-48b4-b875-c3f20448ac21","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":59.912854030501094,"y":12.958963282937365,"width":7.843137254901961,"height":73.43412526997841,"action":{"library":"H5P.Image 1.1","params":{"decorative":false,"contentName":"Image","file":{"path":"images\/file-649c386a97a6d.png","mime":"image\/png","copyright":{"license":"U"},"width":189,"height":910}},"subContentId":"dafd4048-ac8b-4051-a4f2-c30bcc521b88","metadata":{"contentType":"Image","license":"U","title":"Untitled Image"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":69.71677559912854,"y":17.278617710583152,"width":17.429193899782135,"height":12.958963282937365,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
Clinical severity
\nCNS involvement<\/p>\n"},"subContentId":"991dd67c-e694-4e8c-9036-bcfeb7e46e53","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":69.71677559912854,"y":43.196544276457885,"width":17.429193899782135,"height":12.958963282937365,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
Presence of complications<\/p>\n"},"metadata":{"contentType":"Text","license":"U","title":"Untitled Text"},"subContentId":"ce7c360c-ba7e-4110-af97-d361d97e46ba"},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":69.71677559912854,"y":73.43412526997841,"width":17.429193899782135,"height":12.958963282937365,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
Exclusion of other diagnoses<\/p>\n"},"metadata":{"contentType":"Text","license":"U","title":"Untitled Text"},"subContentId":"fd98d383-dc4f-4111-9e8e-87a7a88d5ab8"},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""}],"slideBackgroundSelector":{}},{"elements":[{"x":4.3544662309368185,"y":8.656177105831533,"width":31.59041394335512,"height":8.639308855291576,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
Diagnostic Algorithm<\/span><\/span><\/strong><\/span><\/p>\n"},"subContentId":"cbbcea76-37e4-4024-9885-5ee939929a47","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":4.357298474945534,"y":19.43844492440605,"width":13.071895424836601,"height":6.479481641468682,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
Categories <\/span><\/strong><\/p>\n"},"subContentId":"ec6cd16f-73d2-4561-9965-12b1502a202c","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":11.982570806100219,"y":15.11879049676026,"width":79.8474945533769,"height":75.5939524838013,"action":{"library":"H5P.Image 1.1","params":{"decorative":false,"contentName":"Image","file":{"path":"images\/file-649c3d5631e82.png","mime":"image\/png","copyright":{"license":"U"},"width":1852,"height":889}},"subContentId":"0f3b628a-b3d4-4407-9490-f0931e19a312","metadata":{"contentType":"Image","license":"U","title":"Untitled Image"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":4.357298474945534,"y":84.23326133909288,"width":65.359477124183,"height":8.639308855291576,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
Causative organisms<\/strong><\/span> \u2013 Bacterial, Viral, Fungal, Mycobacterial, Parasitic <\/p>\n"},"subContentId":"3d57b38e-4b1b-42b4-84b8-5b78fad2b67e","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""}],"slideBackgroundSelector":{}},{"elements":[{"x":26.140958605664487,"y":2.159827213822894,"width":50.871459694989106,"height":97.8401727861771,"action":{"library":"H5P.Image 1.1","params":{"decorative":false,"contentName":"Image","file":{"path":"images\/file-649c3db1aa6e4.png","mime":"image\/png","copyright":{"license":"U"},"width":1610,"height":1567}},"subContentId":"c5738610-f716-4150-99a4-04c0d5a1f167","metadata":{"contentType":"Image","license":"U","title":"Untitled Image"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":4.357298474945534,"y":6.479481641468682,"width":25.05446623093682,"height":5.183585313174946,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
Approach to CNS infection <\/strong><\/p>\n"},"subContentId":"63752654-70a3-475f-8417-0c1cc3f554de","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""}],"slideBackgroundSelector":{}},{"elements":[{"x":26.143790849673202,"y":0,"width":44.66230936819172,"height":100,"action":{"library":"H5P.Image 1.1","params":{"decorative":false,"contentName":"Image","file":{"path":"images\/file-649c3dd865964.png","mime":"image\/png","copyright":{"license":"U"},"width":1690,"height":1921}},"subContentId":"c43114b7-d460-4d1a-b449-54d31b46be8a","metadata":{"contentType":"Image","license":"U","title":"Untitled Image"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":4.357298474945534,"y":6.479481641468682,"width":25.05446623093682,"height":5.183585313174946,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
Approach to CNS TB<\/strong><\/p>\n"},"metadata":{"contentType":"Text","license":"U","title":"Untitled Text"},"subContentId":"70a8ad5c-98f8-4c68-94ae-f65c65f44a1c"},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""}],"slideBackgroundSelector":{}},{"elements":[{"x":25.05446623093682,"y":0,"width":44.66230936819172,"height":100,"action":{"library":"H5P.Image 1.1","params":{"decorative":false,"contentName":"Image","file":{"path":"images\/file-649c3debef35f.png","mime":"image\/png","copyright":{"license":"U"},"width":1690,"height":1921}},"subContentId":"1e9ddf18-5cca-4d9e-9466-65f0d3cf9299","metadata":{"contentType":"Image","license":"U","title":"Untitled Image"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":4.357298474945534,"y":6.479481641468682,"width":25.05446623093682,"height":5.183585313174946,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
Approach to CNS TB<\/strong><\/p>\n"},"metadata":{"contentType":"Text","license":"U","title":"Untitled Text"},"subContentId":"609300a0-0b30-4db6-bc90-1cbbf5ede1e6"},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""}],"slideBackgroundSelector":{}},{"elements":[{"x":4.357298474945534,"y":4.319654427645788,"width":39.97821350762527,"height":8.639308855291576,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
TB Meningitis \u2013 diagnostic criteria<\/span><\/span><\/strong><\/span><\/p>\n"},"subContentId":"1f269e39-029e-4810-b200-561f658fc955","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":5.446623093681917,"y":15.11879049676026,"width":46.84095860566449,"height":82.07343412526998,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
A. Clinical <\/strong><\/span><\/p>\n\n
\n\t
Fever and headache lasting for more than 14 days (mandatory)<\/li>\n\t
Vomiting, alteration of sensorium or focal deficit (optional)<\/li>\n<\/ul>\n\n

\nB. Cerebrospinal fluid <\/strong><\/span><\/p>\n\n
\n\t
Pleocytosis with more than 20 cells, predominantly (greater than 60%) lymphocytes, protein greater than 100 mg%, sugars less than 60% of corresponding blood sugars<\/li>\n\t
Negative India ink studies and cytology for malignant cells (in relevant situations)<\/li>\n<\/ul>\n"},"subContentId":"5b635805-1703-4bd5-b655-e4dd9ca2a1e5","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":54.46623093681917,"y":15.11879049676026,"width":42.48366013071895,"height":79.91360691144709,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
C. Radiological <\/strong><\/span><\/p>\n\n
\n\t
CT head showing 2 or more:
\n\t1. Exudates in basal cisterns or in Sylvian fissures
\n\t2. Hydrocephalus
\n\t3. Infarcts
\n\t4. Gyral enhancement<\/li>\n<\/ul>\n\n
D. Extra neural tuberculosis <\/strong><\/span><\/p>\n\n
\n\t
Active TB of lungs, G.I.T, G.U.T, lymph nodes, skeletal system or skin - by radiological or microbiological tests or by presence of caseation necrosis on histopathological examination. <\/li>\n<\/ul>\n"},"subContentId":"9e6815d6-466d-41b6-b113-4b0b9c196f3d","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":52.287581699346404,"y":17.278617710583152,"width":0.10893246187363835,"height":77.7537796976242,"action":{"library":"H5P.Shape 1.0","params":{"line":{"borderWidth":"2","borderStyle":"solid","borderColor":"rgb(126, 124, 124)"},"type":"vertical-line","shape":{"fillColor":"#ffffff","borderColor":"#000000","borderWidth":"0","borderStyle":"solid","borderRadius":"0"}},"subContentId":"e48aa91f-0150-4712-a5ac-fb8a71e5e5e9","metadata":{"contentType":"Shapes","license":"U"}},"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false},{"x":53.37407407407407,"y":89.09287257019439,"width":44.66230936819172,"height":8.639308855291576,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
Ahuja et al. - Diagnostic criteria for tuberculosis meningitis and their validation 1994<\/span><\/p>\n"},"subContentId":"0f584306-f36e-476e-b38b-cd5ea6e68ba1","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""}],"slideBackgroundSelector":{}},{"elements":[{"x":4.357298474945534,"y":4.319654427645788,"width":39.97821350762527,"height":8.639308855291576,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
TB Meningitis \u2013 diagnostic criteria<\/span><\/span><\/strong><\/span><\/p>\n"},"subContentId":"27f366fc-ace3-4d95-80e9-d06cb3c65873","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":5.442363834422658,"y":15.160971922246222,"width":43.57298474945534,"height":75.5939524838013,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
1. Definite tuberculous meningitis <\/strong><\/span>
\n   (i) Clinical criteria (A)
\n   (ii) Bacterial isolation from CSF or tissue biopsy
\n
\n2. Highly probable tuberculous meningitis <\/strong><\/span>
\n   (i) Clinical criteria (A)
\n   (ii) All 3 of(B) and (C) and (D) <\/p>\n\n
3. Probable tuberculous meningitis <\/span><\/strong>
\n   (i) Clinical criteria (A)
\n   (ii) Any 2 of B, C and D
\n
\n4. Possible tuberculous meningitis <\/strong><\/span>
\n   (i) Clinical criteria (A)
\n   (ii) Any one of (B) (C) and (D) <\/p>\n"},"subContentId":"2cc26ed4-ffec-4127-be37-3d62657c6df4","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":52.287581699346404,"y":88.55291576673866,"width":46.62309368191721,"height":8.639308855291576,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
Ahuja et al. - Diagnostic criteria for tuberculosis meningitis and their validation 1994<\/span><\/p>\n"},"subContentId":"be5f7fe7-63ff-4692-a9e4-a95996dca058","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":44.66230936819172,"y":69.11447084233261,"width":51.19825708061002,"height":15.11879049676026,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
Accuracy and positive predictive value were 91.7% 66.7% and 38.5% in the highly probable, probable and possible TBM groups respectively<\/em><\/p>\n"},"subContentId":"273fc5ae-fc1d-415f-a3f0-a5e2d9413a98","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""}],"slideBackgroundSelector":{}},{"elements":[{"x":4.3544662309368185,"y":4.325269978401728,"width":42.48366013071895,"height":8.639308855291576,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
TB Meningitis \u2013 MRC grading (severity)<\/span><\/span><\/strong><\/span><\/p>\n"},"subContentId":"6541b3e6-338f-40c4-bbcf-c03f3cb3e200","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":5.439531590413943,"y":15.189092872570194,"width":91.50326797385621,"height":66.95464362850971,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
Grade 1 TBM :<\/strong> MILD<\/span><\/strong> - Glasgow coma score (GCS) of 15 with no focal neurological deficit; those without altered consciousness or focal neurological signs<\/p>\n\n
Grade 2 TBM: MODERATE<\/span><\/strong> - GCS of 15 with a focal neurological deficit, or a GCS of 11\u201314; those with altered consciousness who are not comatose and those with moderate neurological signs, e.g. single cranial nerve palsies, paraparesis, and hemiparesis<\/p>\n\n
G rade 3 TBM:<\/strong> SEVERE <\/span><\/strong>- GCS of \u226410; for comatose patients and those with multiple cranial nerve palsies, hemiplegia or paraplegia, or both.<\/p>\n\n
Enables stratification of patients and is useful to predict prognosis<\/p>\n"},"subContentId":"d609f801-df6e-46ea-b8b4-a9ad8bdf8293","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":47.930283224400874,"y":88.55291576673866,"width":50.98039215686275,"height":6.479481641468682,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
MRC.(1948) Medical research council report . Streptomycin treatment of TBM lancet 1,582-96 <\/span><\/p>\n"},"subContentId":"f890b5ca-4503-403d-b030-797ba99817d7","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""}],"slideBackgroundSelector":{}},{"elements":[{"x":4.3544662309368185,"y":4.325269978401728,"width":42.48366013071895,"height":8.639308855291576,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
TB Meningitis \u2013 Drug resistance <\/span><\/span><\/strong><\/span><\/p>\n"},"subContentId":"cf51328d-1604-4c73-9102-86a244795053","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":5.4409477124183,"y":10.832872570194384,"width":54.46623093681917,"height":84.23326133909288,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
\n\t
Emerging problem of drug resistance in TB meningitis<\/li>\n\t
Alarming proportion, particularly in developing countries<\/li>\n\t
Nagarathna S et al (2008) reported - 17 % (65) drug resistance cases of TBM (n = 366)<\/li>\n<\/ul>\n\n
a) Resistance to one or combination of drugs
\n b) Most common \u2013 Isoniazid monoresistance (46\/65)<\/p>\n\n
\n\t
Drug resistance detected by \u2013 <\/li>\n<\/ul>\n\n
a) Culture \u2013 MGIT \/ LJ
\n b) Molecular methods \u2013 CBNAAT, LPA<\/p>\n\n
\n\t
Treatment \u2013 guided by drug susceptibility reports<\/li>\n<\/ul>\n\n
a) Conventional MDR or XDR regimen is preferred<\/p>\n"},"subContentId":"4d01e480-9d56-4f3b-ad57-e761f3e60e4b","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":54.46623093681917,"y":90.71274298056156,"width":45.53376906318083,"height":6.479481641468682,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
Nagarathna S et al - Drug susceptibility profiling of tuberculous meningitis (2008)<\/span><\/p>\n"},"subContentId":"766d6aeb-a4b0-4e17-8b9f-b11b64e27276","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":59.912854030501094,"y":23.758099352051836,"width":35.947712418300654,"height":61.12311015118791,"action":{"library":"H5P.Image 1.1","params":{"decorative":false,"contentName":"Image","file":{"path":"images\/file-649d1e21a3898.png","mime":"image\/png","copyright":{"license":"U"},"width":637,"height":548}},"subContentId":"a7d84879-3f96-4f7d-b3be-4299aa8b3c86","metadata":{"contentType":"Image","license":"U","title":"Untitled Image"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""}],"slideBackgroundSelector":{}},{"elements":[{"x":4.3544662309368185,"y":4.325269978401728,"width":42.48366013071895,"height":8.639308855291576,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
CSF Collection and Analysis <\/span><\/span><\/strong><\/span><\/p>\n"},"subContentId":"b715eae1-8863-485a-9e17-f7e0c89a5950","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":5.443790849673203,"y":8.656177105831533,"width":90.41394335511983,"height":84.23326133909288,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
\n\t
Sample collection:
\n\ta) At least 10-15 ml of CSF , under aseptic precautions
\n\tb) Must be seen under microscope with in 30 minutes for correct cell morphology
\n\tc) Must be paired with concurrent blood sample for blood sugar<\/li>\n\t
Appearance: Turbid*, cobweb, xanthochromia <\/li>\n\t
Cell count - 20-1000 ( 0-2400 cells\/cumm)
\n\ta) Predominantly lymphocytic
\n\tb) In acute stage - polymorphonuclear response may occur transiently<\/li>\n\t
Protein - generally 100 - 2000 mg\/dl
\n\ta) Collect sample in heparinized vial - correct protein value can be assessed
\n\t(formation of coagulum may give incorrect value of protein)<\/li>\n\t
Glucose : Less than 40 per cent of corresponding blood glucose level
\n\t
\n\t*to be compared with water against a white background<\/em><\/span><\/li>\n<\/ul>\n"},"subContentId":"d86dbc2b-bbd1-4cd7-9d5d-fec2253faaa9","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":70.80610021786492,"y":75.5939524838013,"width":26.143790849673202,"height":23.758099352051836,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
Index TB Guidelines 2016;
\nGoyal, Vinay, et al. \u201cPractice Trends in Treating CNS TB and Outcomes at a Tertiary Care Hospital: A Cohort Study of 244 Cases.2019 <\/span><\/p>\n"},"subContentId":"33e520bf-d81a-4b8e-9b19-cf9489db249a","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""}],"slideBackgroundSelector":{}},{"elements":[{"x":4.3544662309368185,"y":4.325269978401728,"width":42.48366013071895,"height":8.639308855291576,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
CSF AFB Staining <\/span><\/span><\/strong><\/span><\/p>\n"},"subContentId":"f7c07683-1712-417a-949c-f22120149d46","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":5.446623093681917,"y":8.639308855291576,"width":90.41394335511983,"height":49.676025917926566,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
\n\t
\n\t
Demonstration of AFB in the CSF - rate of detection from 12.5 to 69 %<\/p>\n\t<\/li>\n\t
\n\t
Limit of detection (LOD) - 10000 bacilli<\/p>\n\t<\/li>\n\t
\n\t
Increasing volume increases LOD (staining multiple CSF samples enhanced the sensitivity to 86%)<\/p>\n\t<\/li>\n\t
\n\t
For smear - 3 drop method to be used for maximum concentration. Keep 1 drop of CSF, let it dry, keep another drop-dry and then third drop and dry. Heat fix & proceed with fluorescent staining or ZN staining.<\/p>\n\t<\/li>\n<\/ul>\n"},"subContentId":"ee961826-737e-4cd4-8bef-9abba1723e5d","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":65.359477124183,"y":49.676025917926566,"width":28.43137254901961,"height":45.35637149028078,"action":{"library":"H5P.Image 1.1","params":{"decorative":false,"contentName":"Image","file":{"path":"images\/file-649d1f4cc04b0.png","mime":"image\/png","copyright":{"license":"U"},"width":543,"height":438}},"subContentId":"4bc13e65-2d3d-449c-8307-55674a7fecca","metadata":{"contentType":"Image","license":"U","title":"Untitled Image"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""}],"slideBackgroundSelector":{}},{"elements":[{"x":4.3544662309368185,"y":4.325269978401728,"width":42.48366013071895,"height":8.639308855291576,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
CSF NAAT Test<\/strong><\/p>\n"},"subContentId":"a4385705-fda9-4bf2-a2c1-dc6a42520fa8","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":5.442363834422658,"y":2.159827213822894,"width":62.091503267973856,"height":75.5939524838013,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
\u200b\u200b\u200b\u200b\u200b\u200b<\/p>\n\n
\n\t
\n\t
Semi-quantitative nested real-time PCR<\/p>\n\t<\/li>\n\t
\n\t
Target 81 bp segment on rpoB gene<\/p>\n\t<\/li>\n\t
\n\t
Designed to simultaneously detect Mtb as well as Rifampicin resistance<\/p>\n\t<\/li>\n\t
\n\t
LOD - 131 CFU\/ml<\/p>\n\t<\/li>\n\t
\n\t
CSF - pooled sensitivity 79.5% specificity 97.8% (vs culture) <\/p>\n\t<\/li>\n\t
\n\t
Sensitivity - 55%, negative predictive value 84% (vs clinical diagnosis)<\/p>\n\t<\/li>\n\t
\n\t
Negative result does not rule out TB meningitis<\/p>\n\t<\/li>\n<\/ul>\n"},"subContentId":"63b97b04-bd6b-47c2-a6e9-4390d224027c","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":67.53812636165577,"y":8.639308855291576,"width":28.21350762527233,"height":51.83585313174946,"action":{"library":"H5P.Image 1.1","params":{"decorative":false,"contentName":"Image","file":{"path":"images\/file-649d20e6d7e5f.png","mime":"image\/png","copyright":{"license":"U"},"width":345,"height":320}},"subContentId":"e9baa9ef-f6a3-4129-baee-0fc1115b5ace","metadata":{"contentType":"Image","license":"U","title":"Untitled Image"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":6.5359477124183005,"y":71.27429805615552,"width":61.00217864923747,"height":24.406047516198704,"action":{"library":"H5P.Image 1.1","params":{"decorative":false,"contentName":"Image","file":{"path":"images\/file-649d2141642a6.png","mime":"image\/png","copyright":{"license":"U"},"width":1463,"height":241}},"subContentId":"fd9590e6-e15e-4d3f-9b8c-5d9a0cbb9353","metadata":{"contentType":"Image","license":"U","title":"Untitled Image"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":71.89542483660131,"y":75.5939524838013,"width":23.965141612200437,"height":19.43844492440605,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
Sharma S K et al - Evaluation of Xpert MTB\/RIF assay performance in diagnosing EPTB among adults in a tertiary care centre in India, 2014<\/span><\/p>\n"},"subContentId":"2a0c9062-28bc-4131-b6f7-edd63c49deac","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""}],"slideBackgroundSelector":{}},{"elements":[{"x":4.3544662309368185,"y":4.325269978401728,"width":42.48366013071895,"height":8.639308855291576,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
CSF- Culture- MGIT\/LJ<\/strong><\/p>\n"},"subContentId":"a354218f-bc41-4221-a5fc-79dbbc885019","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":5.443790849673203,"y":10.816004319654429,"width":88.23529411764706,"height":58.31533477321815,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
\n\t
\n\t
\u200b\u200b\u200b\u200bLiquid (MGIT) is preferred method, if not available then solid (LJ)<\/p>\n\t<\/li>\n\t
\n\t
Liquid culture- shorter time to positivity<\/p>\n\t<\/li>\n\t
\n\t
Positivity of CSF culture 25 - 70 % (LJ and MGIT)<\/p>\n\t<\/li>\n\t
\n\t
Repeated cultures of CSF samples - increased sensitivity from 52 % for first culture to up to 83 % after four cultures.<\/p>\n\t<\/li>\n\t
\n\t
Cultures from extra-neural sites such as the sputum, lymph node and bone marrow may be positive<\/p>\n\t<\/li>\n\t
\n\t
Useful for drug susceptibility testing <\/p>\n\t<\/li>\n<\/ul>\n"},"subContentId":"7376f494-5a2f-4278-95b7-ab23de92a154","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""}],"slideBackgroundSelector":{}},{"elements":[{"x":4.3544662309368185,"y":4.325269978401728,"width":42.48366013071895,"height":8.639308855291576,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
CNS TB - Other CSF based diagnostic tests <\/strong><\/p>\n"},"subContentId":"0c678742-8d34-4cf5-a6e0-c6168bd705c5","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":5.436699346405229,"y":10.85818574514039,"width":90.41394335511983,"height":51.83585313174946,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
\n\t
Line Probe assay to be used for DST after culture positive<\/li>\n<\/ul>\n\n
a) DNA extraction- amplification \u2013 reverse hybridization
\n b) May be used in AFB positive- 55% positivity rate in microbiologically confirmed TB
\n c) Designed to simultaneously detect Isoniazid and Rifampicin resistance<\/p>\n\n
\n\t
ADA - standardized cutoffs values for diagnosis of TBM have not been established<\/li>\n<\/ul>\n\n
a) value of > 9 - estimated sensitivity and specificity of ADA for TBM to be <59 and 96 %, respectively
\n b) Not recommended <\/strong><\/p>\n"},"subContentId":"e8421e67-8e4f-4128-9769-179121c59e77","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""}],"slideBackgroundSelector":{}},{"elements":[{"x":4.3544662309368185,"y":4.325269978401728,"width":42.48366013071895,"height":8.639308855291576,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
Exclusion of alternative diagnosis*<\/strong><\/p>\n"},"subContentId":"41724173-eb7f-4a4b-ad36-356c7557472f","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":5.446623093681917,"y":15.11879049676026,"width":90.41394335511983,"height":51.83585313174946,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
Investigations<\/p>\n\n
\n\t
\n\t
CSF Cryptococcal Ag (CrAg) & India ink; fungal culture to be done as per feasibility<\/p>\n\t<\/li>\n\t
\n\t
Malignant cytology<\/p>\n\t<\/li>\n\t
\n\t
CSF Bacterial culture<\/p>\n\t<\/li>\n\t
\n\t
CSF VDRL<\/p>\n\t<\/li>\n<\/ul>\n"},"subContentId":"d1124321-d7c1-4a37-b47c-5679ca109a07","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":6.5359477124183005,"y":62.634989200863934,"width":53.37690631808279,"height":8.639308855291576,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
*workup required wherever feasible and clinically indicated<\/em><\/span><\/p>\n"},"subContentId":"074f7ba7-2f79-4594-ae84-58eab5ba6035","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""}],"slideBackgroundSelector":{}},{"elements":[{"x":4.357298474945534,"y":6.479481641468682,"width":42.48366013071895,"height":8.639308855291576,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
Radiologial Diagnosis - CT Scan <\/strong><\/p>\n"},"subContentId":"f7825674-d27e-4650-b0d8-e1d7da0f957f","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":5.443790849673203,"y":15.146911447084232,"width":39.21568627450981,"height":69.11447084233261,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
\n\t
\n\t
Hydrocephalus<\/p>\n\t<\/li>\n\t
\n\t
Hyper-density in basal cisterns on non-contrast scans<\/p>\n\t<\/li>\n\t
\n\t
Basal meningeal enhancement<\/p>\n\t<\/li>\n\t
\n\t
Infarctions<\/p>\n\t<\/li>\n\t
\n\t
Tucerculoma <\/p>\n\t<\/li>\n\t
\n\t
Tubercular abscess<\/p>\n\t<\/li>\n\t
\n\t
Associated skull lesions<\/p>\n\t<\/li>\n<\/ul>\n"},"subContentId":"a04770b7-080c-4bf6-aecd-255d653aab1e","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":52.287581699346404,"y":6.479481641468682,"width":40.52287581699346,"height":90.71274298056156,"action":{"library":"H5P.Image 1.1","params":{"decorative":false,"contentName":"Image","file":{"path":"images\/file-649d254212e9e.png","mime":"image\/png","copyright":{"license":"U"},"width":827,"height":935}},"subContentId":"ea1bb2b5-66ec-488a-9c05-b782d680951c","metadata":{"contentType":"Image","license":"U","title":"Untitled Image"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""}],"slideBackgroundSelector":{}},{"elements":[{"x":4.357298474945534,"y":6.479481641468682,"width":42.48366013071895,"height":8.639308855291576,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
Radiologial Diagnosis - CT Scan <\/strong><\/p>\n"},"subContentId":"7caaee13-4589-4292-a2e5-2075e541feb9","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":5.443790849673203,"y":15.146911447084232,"width":39.21568627450981,"height":69.11447084233261,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
\n\t
\n\t
Hydrocephalus<\/p>\n\t<\/li>\n\t
\n\t
Hyper-density in basal cisterns on non-contrast scans<\/p>\n\t<\/li>\n\t
\n\t
Basal meningeal enhancement<\/p>\n\t<\/li>\n\t
\n\t
Infarctions<\/p>\n\t<\/li>\n\t
\n\t
Tucerculoma <\/p>\n\t<\/li>\n\t
\n\t
Tubercular abscess<\/p>\n\t<\/li>\n\t
\n\t
Associated skull lesions<\/p>\n\t<\/li>\n<\/ul>\n"},"subContentId":"b42af036-fb9d-43fd-9fdc-800c9313a28d","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":52.287581699346404,"y":6.479481641468682,"width":40.49711466276602,"height":90.71274298056156,"action":{"library":"H5P.Image 1.1","params":{"decorative":false,"contentName":"Image","file":{"path":"images\/file-649d29ee1d183.png","mime":"image\/png","copyright":{"license":"U"},"width":806,"height":914}},"subContentId":"f28eef1a-c585-448e-9096-b2c4f4c0d05e","metadata":{"contentType":"Image","license":"U","title":"Untitled Image"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""}],"slideBackgroundSelector":{}},{"elements":[{"x":4.357298474945534,"y":6.479481641468682,"width":42.48366013071895,"height":8.639308855291576,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
Radiologial Diagnosis - CT Scan <\/strong><\/p>\n"},"subContentId":"232b041f-f676-4d71-9260-406242177970","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":5.443790849673203,"y":15.146911447084232,"width":39.21568627450981,"height":69.11447084233261,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
\n\t
\n\t
Hydrocephalus<\/p>\n\t<\/li>\n\t
\n\t
Hyper-density in basal cisterns on non-contrast scans<\/p>\n\t<\/li>\n\t
\n\t
Basal meningeal enhancement<\/p>\n\t<\/li>\n\t
\n\t
Infarctions<\/p>\n\t<\/li>\n\t
\n\t
Tucerculoma <\/p>\n\t<\/li>\n\t
\n\t
Tubercular abscess<\/p>\n\t<\/li>\n\t
\n\t
Associated skull lesions<\/p>\n\t<\/li>\n<\/ul>\n"},"subContentId":"7778c59a-5a75-40cc-b07a-d51a552f6b8e","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":52.287581699346404,"y":6.479481641468682,"width":39.56715903500013,"height":90.71274298056156,"action":{"library":"H5P.Image 1.1","params":{"decorative":false,"contentName":"Image","file":{"path":"images\/file-649d2a1dbf2c7.png","mime":"image\/png","copyright":{"license":"U"},"width":803,"height":932}},"subContentId":"be09e3e7-aade-42de-af9e-45393d0b310a","metadata":{"contentType":"Image","license":"U","title":"Untitled Image"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""}],"slideBackgroundSelector":{}},{"elements":[{"x":4.357298474945534,"y":6.479481641468682,"width":42.48366013071895,"height":8.639308855291576,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
Radiologial Diagnosis - MRI<\/strong><\/p>\n"},"subContentId":"bba3d9b6-e610-4f6f-a579-df87e9b74241","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":5.439531590413943,"y":15.189092872570194,"width":43.57298474945534,"height":73.43412526997841,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
TBM \u2013 T1 post contrast basal meningeal enhancement<\/p>\n\n
\n\t
\n\t
Ischemic infarct <\/p>\n\t<\/li>\n\t
\n\t
Cranial nerve involvement - appear thickened, especially in proximal segments,
\n\t
\n\ta) With high signal intensity on t2-weighted images and
\n\tb) Marked enhancement on postcontrast images.<\/p>\n\t<\/li>\n<\/ul>\n"},"subContentId":"dc5e238d-75e2-43f2-92e8-148a841a6b52","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":52.287581699346404,"y":6.479481641468682,"width":36.24378458176988,"height":90.71274298056156,"action":{"library":"H5P.Image 1.1","params":{"decorative":false,"contentName":"Image","file":{"path":"images\/file-649d2bf0a2559.png","mime":"image\/png","copyright":{"license":"U"},"width":820,"height":1039}},"subContentId":"97bc55ca-ed76-405b-a5f8-350b7b88796c","metadata":{"contentType":"Image","license":"U","title":"Untitled Image"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""}],"slideBackgroundSelector":{}},{"elements":[{"x":5.446623093681917,"y":4.319654427645788,"width":89.32461873638344,"height":47.51619870410367,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
\n\t
Focal tuberculous cerebritis - <\/strong> T1 hypo and T2 hypersignal intensities ; small areas of patchy enhancement on postcontrast.<\/li>\n\t
Tuberculous abscess - <\/strong> central area of liquefaction with pus. May be solitary or multiple and is frequently multiloculated<\/li>\n\t
Hypodense with peripheral edema and mass effect on CT.
\n\ta) On T2-weighted images, central necrotic area has increased signal intensity.
\n\tb) Postcontrast - ring enhancement, usually thin and uniform, may be irregular and thick<\/li>\n<\/ul>\n"},"subContentId":"b37ece64-9ab6-41bc-922f-7c481c624c3a","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":25.05446623093682,"y":49.676025917926566,"width":52.94117647058824,"height":48.16414686825054,"action":{"library":"H5P.Image 1.1","params":{"decorative":false,"contentName":"Image","file":{"path":"images\/file-649d2c1532423.png","mime":"image\/png","copyright":{"license":"U"},"width":1803,"height":585}},"subContentId":"6c345e8a-865b-46f4-a60b-6a22f98095fa","metadata":{"contentType":"Image","license":"U","title":"Untitled Image"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""}],"slideBackgroundSelector":{}},{"elements":[{"x":4.357298474945534,"y":6.479481641468682,"width":42.48366013071895,"height":8.639308855291576,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
Tuberculomas vs Neurocysticercosis <\/strong><\/p>\n"},"subContentId":"152f3e06-d473-4cf9-a819-3ca4a158f929","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":6.5359477124183005,"y":15.11879049676026,"width":41.394335511982575,"height":73.43412526997841,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
NCC<\/strong><\/span><\/p>\n\n
\n\t
Lesions are <20 mm and may be single or multiple.<\/li>\n\t
Meningitis feature is not there.<\/li>\n\t
Present at grey-white matter junction.<\/li>\n\t
Other involvements like eyes, muscles or subcutaneous tissues.<\/li>\n\t
T2W shows hyper intensity with hypointense scolex in it. No midline shift and ring enhancement is there depending upon the staging.<\/li>\n\t
MR spectroscopy shows multiple amino acid peaks.<\/li>\n<\/ul>\n"},"subContentId":"3a979288-9ae2-4237-b418-3d8d0ff16dbf","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":52.287581699346404,"y":15.11879049676026,"width":42.48366013071895,"height":73.43412526997841,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
Tuberculoma<\/strong><\/span><\/p>\n\n
\n\t
Often multiple and >20 mm because of conglomeration.<\/li>\n\t
Meningitis is usually associated.<\/li>\n\t
More common in posterior fossa.<\/li>\n\t
Spread is mostly secondary to infection somewhere else.<\/li>\n\t
Hypointensity seen in T2W and midline shift may be present.<\/li>\n\t
MR Spectroscopy shows lipid peak.<\/li>\n<\/ul>\n"},"subContentId":"3b332370-bb21-4fee-b7e3-083701bc8304","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":65.359477124183,"y":90.71274298056156,"width":31.59041394335512,"height":6.479481641468682,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
Sharma B.B et al \u2013 NCC vs CNS tuberculomas - 2016<\/span><\/p>\n"},"subContentId":"660bfd0a-e004-4325-ad6a-f2b6d12c31bc","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":47.92745098039216,"y":15.146911447084232,"width":0.10893246187363835,"height":71.27429805615552,"action":{"library":"H5P.Shape 1.0","params":{"line":{"borderWidth":"2","borderStyle":"solid","borderColor":"rgb(126, 124, 124)"},"type":"vertical-line","shape":{"fillColor":"#ffffff","borderColor":"#000000","borderWidth":"0","borderStyle":"solid","borderRadius":"0"}},"metadata":{"contentType":"Shapes","license":"U"},"subContentId":"5cbdd685-f4dc-4dc6-925f-9f9bd30676c0"},"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false}],"slideBackgroundSelector":{}}],"keywordListEnabled":true,"globalBackgroundSelector":{},"keywordListAlwaysShow":false,"keywordListAutoHide":false,"keywordListOpacity":90},"override":{"activeSurface":false,"hideSummarySlide":false,"summarySlideSolutionButton":true,"summarySlideRetryButton":true,"enablePrintButton":false,"social":{"showFacebookShare":false,"facebookShare":{"url":"@currentpageurl","quote":"I scored @score out of @maxScore on a task at @currentpageurl."},"showTwitterShare":false,"twitterShare":{"statement":"I scored @score out of @maxScore on a task at @currentpageurl.","url":"@currentpageurl","hashtags":"h5p, course"},"showGoogleShare":false,"googleShareUrl":"@currentpageurl"}},"l10n":{"slide":"Slide","score":"Score","yourScore":"Your Score","maxScore":"Max Score","total":"Total","totalScore":"Total Score","showSolutions":"Show solutions","retry":"Retry","exportAnswers":"Export text","hideKeywords":"Hide sidebar navigation menu","showKeywords":"Show sidebar navigation menu","fullscreen":"Fullscreen","exitFullscreen":"Exit fullscreen","prevSlide":"Previous slide","nextSlide":"Next slide","currentSlide":"Current slide","lastSlide":"Last slide","solutionModeTitle":"Exit solution mode","solutionModeText":"Solution Mode","summaryMultipleTaskText":"Multiple tasks","scoreMessage":"You achieved:","shareFacebook":"Share on Facebook","shareTwitter":"Share on Twitter","shareGoogle":"Share on Google+","summary":"Summary","solutionsButtonTitle":"Show comments","printTitle":"Print","printIngress":"How would you like to print this presentation?","printAllSlides":"Print all slides","printCurrentSlide":"Print current slide","noTitle":"No title","accessibilitySlideNavigationExplanation":"Use left and right arrow to change slide in that direction whenever canvas is selected.","accessibilityCanvasLabel":"Presentation canvas. Use left and right arrow to move between slides.","accessibilityProgressBarLabel":"Choose slide to display","containsNotCompleted":"@slideName contains not completed interaction","containsCompleted":"@slideName contains completed interaction","slideCount":"Slide @index of @total","containsOnlyCorrect":"@slideName only has correct answers","containsIncorrectAnswers":"@slideName has incorrect answers","shareResult":"Share Result","accessibilityTotalScore":"You got @score of @maxScore points in total","accessibilityEnteredFullscreen":"Entered fullscreen","accessibilityExitedFullscreen":"Exited fullscreen","confirmDialogHeader":"Submit your answers","confirmDialogText":"This will submit your results, do you want to continue?","confirmDialogConfirmText":"Submit and see results","slideshowNavigationLabel":"Slideshow navigation"}}

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Diagnosis of CNS TB

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Diagnosis of CNS TB

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