{"presentation":{"slides":[{"elements":[{"x":4.357298474945534,"y":6.479481641468682,"width":27.233115468409586,"height":8.639308855291576,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"

Approach to Managment <\/strong><\/span><\/p>\n"},"subContentId":"08bf8e70-137d-4eeb-9d25-470fa9dba85a","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":17.312354211663067,"width":89.32461873638344,"height":47.51619870410367,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"

Consideration in management of a case of TB meningitis -
\n1. Primary therapy <\/strong>\u2013 Medical therapy in form of antitubercular drugs are the mainstay<\/p>\n\n

2. Complications <\/strong>\u2013 assessing and managing the metabolic or pathological complications
\nMetabolic - Electrolyte disturbances, Pituitary dysfunction
\nMedical \u2013 septic shock, ARDS, co-infections, Stroke due to vasculitis, toxicity of drugs, seizures
\nSurgical \u2013 Hydrocephalus, Raised intracranial pressure<\/p>\n\n

3. Supportive management<\/strong><\/p>\n"},"subContentId":"76403195-fe7f-4635-bbeb-649f72fbde71","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":6.490734341252699,"width":39.21568627450981,"height":8.639308855291576,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"

Medical Treatment Principles <\/strong><\/span><\/p>\n"},"subContentId":"81b42625-3986-461f-9e3c-f8eed1d36059","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":12.958963282937365,"width":39.21568627450981,"height":56.371490280777536,"action":{"library":"H5P.Image 1.1","params":{"decorative":false,"contentName":"Image","file":{"path":"images\/file-649d3528d9a30.png","mime":"image\/png","copyright":{"license":"U"},"width":1087,"height":788}},"subContentId":"be358328-e137-45df-85f2-b35e01f20068","metadata":{"contentType":"Image","license":"U","title":"Untitled Image"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":3.2679738562091503,"y":69.11447084233261,"width":51.19825708061002,"height":21.598272138228943,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"

As mentioned in the table, drugs have increased penetration through inflamed meninges
\nNo data on CSF penetration for Bedaquiline, Delamanid, Clofazimine<\/span><\/p>\n"},"subContentId":"40650ef1-b04c-4e57-b847-817ebef15d91","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":3.2679738562091503,"y":90.71274298056156,"width":33.769063180827885,"height":6.479481641468682,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"

Marx et al , TB research and treatment volume 2011<\/span><\/p>\n"},"subContentId":"e75495f3-5b7b-4181-934a-36dc21ee7d11","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":56.64488017429194,"y":4.319654427645788,"width":39.21568627450981,"height":10.799136069114471,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"

Following table shows comparison of various drugs, activity, CSF penetration, resistance:<\/p>\n"},"subContentId":"dd2ed320-d283-45f4-97e6-a5c0bd464f5a","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":56.64488017429194,"y":17.278617710583152,"width":37.254901960784316,"height":79.91360691144709,"action":{"library":"H5P.Image 1.1","params":{"decorative":false,"contentName":"Image","file":{"path":"images\/file-649d35c28d04f.png","mime":"image\/png","copyright":{"license":"U"},"width":795,"height":865}},"subContentId":"e3fedae6-ad7f-4dd3-8748-8199687a0213","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":6.490734341252699,"width":51.19825708061002,"height":8.639308855291576,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"

Anti-Tubercular Therapy <\/strong><\/span><\/p>\n"},"subContentId":"eb66bea7-60eb-482f-96e0-692cf5d88c3f","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":17.34611231101512,"width":89.32461873638344,"height":73.43412526997841,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"

\n\t
Based on considerations and evidence, following treatment is recommended - <\/li>\n<\/ul>\n\n
a) Intensive phase \u2013 4 drugs HRZ + E\/S x 2 months
\n b) Continuation phase \u2013 3 drugs HRE x at least 10 months
\n (Expert recommendation \u2013 RHZ x at least 10 months)<\/p>\n\n
\n\t
Doses used <\/li>\n<\/ul>\n\n
a) Isoniazid: 5 - 10 mg\/kg\/day (Max. \u2013 300 mg)
\n b) Rifampicin : 10 - 15 g\/kg\/day (Max. \u2013 600mg)
\n c) Ethambutol: 15 - 20 mg\/kg\/day (Max. \u2013 1600mg)
\n d) Pyrazinamide: 20 - 25 mg\/kg\/day (Max \u2013 2000mg)
\n e) Streptomycin: 15 - 25 mg\/kg\/day (Max. \u2013 1000mg)<\/p>\n\n
\n\t
Follow up \u2013 clinically and radiologically<\/li>\n<\/ul>\n"},"subContentId":"ce29f138-d8cc-4e71-96a2-298b39669832","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":6.490734341252699,"width":55.55555555555556,"height":8.639308855291576,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
Role of Steroids in Management of CNS TB <\/strong><\/span><\/p>\n"},"subContentId":"44ea1ac1-fc9b-4423-8290-be3ad6cc9665","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":12.958963282937365,"width":88.23529411764706,"height":62.634989200863934,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
\n\t
Thwaites et al. (2004) <\/li>\n<\/ul>\n\n
a) Reduced risk of death (relative risk, 0.69; 95 percent confidence interval, 0.52 to 0.92; P=0.01)
\n b) No associated significant reduction in proportion of severely disabled patients<\/p>\n\n
\n\t
\n\t
Studies show - steroids associated with reduced risk of death (32 v\/s 41%)<\/p>\n\t<\/li>\n\t
\n\t
Steroids are recommended in - <\/p>\n\t<\/li>\n\t
\n\t
HIV negative patients \u2013 recommended; for at least 4 week<\/p>\n\t<\/li>\n\t
\n\t
HIV positive patients \u2013 may be used; rule out opportunistic infections <\/strong><\/p>\n\t<\/li>\n<\/ul>\n"},"subContentId":"a8ee4f40-66fa-47db-b553-b33ec7e2e5b6","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":23.965141612200437,"y":86.39308855291577,"width":73.52941176470588,"height":10.799136069114471,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
Prasad et al, 2016 Corticosteroids for managing tuberculous meningitis \u2013 Cochrane Review,
\nGuy E. Thwaites et al. - Dexamethasone for the Treatment of Tuberculous Meningitis in Adolescents and Adults \u2013 NEJM 92004)<\/span><\/p>\n"},"subContentId":"095b96a5-2b6d-4709-90be-f59d7e4eea7b","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":6.490734341252699,"width":55.55555555555556,"height":8.639308855291576,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
Role of Steroids in Management of CNS TB <\/strong><\/span><\/p>\n"},"subContentId":"f9c503d4-ed87-4634-9caa-d299949d06e1","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":5.44520697167756,"y":12.992699784017278,"width":87.14596949891067,"height":45.35637149028078,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
\n\t
\n\t
Usual regimen \u2013 <\/p>\n\t<\/li>\n\t
\n\t
IV dexamethasone \u2013 0.4 mg \/Kg x 2 weeks -> 0.3 mg\/kg x 1 week -> 0.2 mg\/Kg x 1 week -> 4 mg\/day x 1 week -> 3 mg\/day x 1 week -> 2 mg\/day x 1 week -> 1 mg\/day x 1 week -> stop<\/strong><\/span><\/p>\n\t<\/li>\n\t
\n\t
In patient \u2013 i.v steroids preferred over oral steroids
\n\tMay be shifted to oral steroids \u2013 after 4 weeks; or on discharge<\/p>\n\t<\/li>\n\t
\n\t
Following conversion may be used - <\/p>\n\t<\/li>\n<\/ul>\n"},"subContentId":"aab5ebca-ffa3-44c5-991a-a4f11505601d","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":23.965141612200437,"y":86.39308855291577,"width":73.52941176470588,"height":10.799136069114471,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
Prasad et al, 2016 Corticosteroids for managing tuberculous meningitis \u2013 Cochrane Review,
\nGuy E. Thwaites et al. - Dexamethasone for the Treatment of Tuberculous Meningitis in Adolescents and Adults \u2013 NEJM 92004)<\/span><\/p>\n"},"subContentId":"9f20de0b-6d70-4d64-ad67-4a10290b2fef","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":40.30501089324619,"y":49.676025917926566,"width":34.85838779956427,"height":36.717062634989205,"action":{"library":"H5P.Table 1.1","params":{"text":"
\n
\n\n\t\n\t<\/colgroup>\n\t\n\t\t\n\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t
Glucocorticoid<\/strong><\/span><\/td>\n\t\t\t Equivalent doses (mg)<\/strong><\/span><\/td>\n\t\t<\/tr>\n\t\t
Hydrocortisone<\/span><\/span><\/span><\/span><\/span><\/span><\/td>\n\t\t\t 20<\/span><\/span><\/span><\/span><\/span><\/span><\/td>\n\t\t<\/tr>\n\t\t
Prednisolone <\/span><\/span><\/span><\/span><\/span><\/span><\/td>\n\t\t\t 5<\/span><\/span><\/span><\/span><\/span><\/span><\/td>\n\t\t<\/tr>\n\t\t
Methylprednisolone<\/span><\/span><\/span><\/span><\/span><\/span><\/td>\n\t\t\t 4<\/span><\/span><\/span><\/span><\/span><\/span><\/td>\n\t\t<\/tr>\n\t\t
Dexamethasone<\/span><\/span><\/span><\/span><\/span><\/span><\/td>\n\t\t\t 0.75<\/span><\/span><\/span><\/span><\/span><\/span><\/td>\n\t\t<\/tr>\n\t<\/tbody>\n<\/table>\n<\/div>\n<\/div>\n"},"subContentId":"b8327c5b-f066-456e-9ed3-971f715ce76e","metadata":{"contentType":"Table","license":"U","title":"Untitled Table"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""}],"slideBackgroundSelector":{}},{"elements":[{"x":4.3544662309368185,"y":6.490734341252699,"width":55.55555555555556,"height":8.639308855291576,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
Tuberculoma & TB abscess <\/strong><\/span><\/p>\n"},"metadata":{"contentType":"Text","license":"U","title":"Untitled Text"},"subContentId":"1e0e47f8-aa4a-4494-88b3-68dbb3901d68"},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":4.3544662309368185,"y":12.981468682505398,"width":88.23529411764706,"height":77.7537796976242,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
\n\t
\n\t
Management includes \u2013 medical therapy or surgery<\/p>\n\t<\/li>\n\t
\n\t
Lack of evidence <\/strong>to show surgical removal without ATT is beneficial over ATT with or without surgery<\/p>\n\t<\/li>\n\t
\n\t
Medical management - <\/strong>ATT with steroids - mainstay <\/p>\n\t<\/li>\n\t
\n\t
Surgery -<\/strong> indicated in special situations - <\/p>\n\t<\/li>\n<\/ul>\n\n
a) Causing obstructive hydrocephalus
\n b) Features of raised ICT
\n c) Large space-occupying tuberculomas with raised ICT
\n d) In addition \u2013 if features of associated compartmental shifts
\n e) Diagnostic dilemma<\/p>\n\n
\n\t
Optimal treatment duration or follow up is not known<\/li>\n<\/ul>\n"},"subContentId":"227b221f-7ca1-47f4-9efe-470ed834ec10","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":6.490734341252699,"width":55.55555555555556,"height":8.639308855291576,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
Tuberculoma & TB abscess <\/strong><\/span><\/p>\n"},"metadata":{"contentType":"Text","license":"U","title":"Untitled Text"},"subContentId":"960bdddb-e73f-4580-9172-6739d8cd821d"},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":4.357298474945534,"y":10.799136069114471,"width":88.23529411764706,"height":84.23326133909288,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
\n\t
Therapy is empirical - based on clinical and radiological features<\/li>\n\t
Diagnostic uncertainty always remains <\/li>\n<\/ul>\n\n
a) Until tissue confirmed using microbiological or histopathological examination<\/p>\n\n
\n\t
Expert recommendations \u2013 <\/strong><\/li>\n<\/ul>\n\n
a) Duration \u2013 12-18 months of therapy may suffice
\n - Lesion may persist after therapy; extended therapy beyond 18 months may not be required
\n b) Imaging \u2013 repeat imaging may not be required unless clinically indicated
\n - New onset seizures, neurological sign or symptoms<\/p>\n\n
\n\t
Response to therapy <\/strong>\u2013 based on clinical assessmen<\/li>\n\t
No partial response implies<\/li>\n<\/ul>\n\n
a) Fever persists; poor general well being; radiological worsening<\/p>\n"},"subContentId":"cc2ca853-7fc2-4769-b56c-b5d4acfba2db","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":6.490734341252699,"width":55.55555555555556,"height":8.639308855291576,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
Tuberculoma & TB abscess <\/strong><\/span><\/p>\n"},"metadata":{"contentType":"Text","license":"U","title":"Untitled Text"},"subContentId":"31c28195-9623-420c-8de4-2893f7257c88"},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":5.443790849673203,"y":19.47781857451404,"width":49.01960784313726,"height":75.5939524838013,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
\n\t
In case of worsening features \u2013 clinical or radiological<\/li>\n\t
IRIS \u2013 usually within 3-6 months of therapy<\/li>\n<\/ul>\n\n
a) Short course of steroids may be added<\/p>\n\n
\n\t
Drug resistant TB<\/li>\n\t
Other infectious causes <\/li>\n<\/ul>\n\n
a) Neurocysticercosis, toxoplasmosis,
\n b) Cryptococcomas<\/p>\n\n
\n\t
Malignancy \u2013 primary or metastatic <\/li>\n<\/ul>\n"},"subContentId":"bb925033-0509-446a-9fcc-4dd8e0b1bb5f","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":53.37690631808279,"y":45.35637149028078,"width":4.205787631090117,"height":40,"action":{"library":"H5P.Image 1.1","params":{"decorative":false,"contentName":"Image","file":{"path":"images\/file-649d6e8b93244.png","mime":"image\/png","copyright":{"license":"U"},"width":189,"height":910}},"subContentId":"1dad1163-9544-4f62-aa61-a34ce25b8cb1","metadata":{"contentType":"Image","license":"U","title":"Untitled Image"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":61.00217864923747,"y":53.99568034557235,"width":31.59041394335512,"height":28.077753779697623,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
following causes requires
\ninvasive tissue sampling and
\nmicrobiological and histopathological examination <\/p>\n"},"subContentId":"909093b4-ed40-4646-94de-3f216716da1c","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""}],"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"}}

Glucocorticoid<\/strong><\/span><\/td>\n\t\t\t	Equivalent doses (mg)<\/strong><\/span><\/td>\n\t\t<\/tr>\n\t\t
Hydrocortisone<\/span><\/span><\/span><\/span><\/span><\/span><\/td>\n\t\t\t	20<\/span><\/span><\/span><\/span><\/span><\/span><\/td>\n\t\t<\/tr>\n\t\t
Prednisolone <\/span><\/span><\/span><\/span><\/span><\/span><\/td>\n\t\t\t	5<\/span><\/span><\/span><\/span><\/span><\/span><\/td>\n\t\t<\/tr>\n\t\t
Methylprednisolone<\/span><\/span><\/span><\/span><\/span><\/span><\/td>\n\t\t\t	4<\/span><\/span><\/span><\/span><\/span><\/span><\/td>\n\t\t<\/tr>\n\t\t
Dexamethasone<\/span><\/span><\/span><\/span><\/span><\/span><\/td>\n\t\t\t	0.75<\/span><\/span><\/span><\/span><\/span><\/span><\/td>\n\t\t<\/tr>\n\t<\/tbody>\n<\/table>\n<\/div>\n<\/div>\n"},"subContentId":"b8327c5b-f066-456e-9ed3-971f715ce76e","metadata":{"contentType":"Table","license":"U","title":"Untitled Table"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""}],"slideBackgroundSelector":{}},{"elements":[{"x":4.3544662309368185,"y":6.490734341252699,"width":55.55555555555556,"height":8.639308855291576,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":" Tuberculoma & TB abscess <\/strong><\/span><\/p>\n"},"metadata":{"contentType":"Text","license":"U","title":"Untitled Text"},"subContentId":"1e0e47f8-aa4a-4494-88b3-68dbb3901d68"},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":4.3544662309368185,"y":12.981468682505398,"width":88.23529411764706,"height":77.7537796976242,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":" \n\t \n\t Management includes \u2013 medical therapy or surgery<\/p>\n\t<\/li>\n\t \n\t Lack of evidence <\/strong>to show surgical removal without ATT is beneficial over ATT with or without surgery<\/p>\n\t<\/li>\n\t \n\t Medical management - <\/strong>ATT with steroids - mainstay <\/p>\n\t<\/li>\n\t \n\t Surgery -<\/strong> indicated in special situations - <\/p>\n\t<\/li>\n<\/ul>\n\n a) Causing obstructive hydrocephalus \n b) Features of raised ICT \n c) Large space-occupying tuberculomas with raised ICT \n d) In addition \u2013 if features of associated compartmental shifts \n e) Diagnostic dilemma<\/p>\n\n \n\t Optimal treatment duration or follow up is not known<\/li>\n<\/ul>\n"},"subContentId":"227b221f-7ca1-47f4-9efe-470ed834ec10","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":6.490734341252699,"width":55.55555555555556,"height":8.639308855291576,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":" Tuberculoma & TB abscess <\/strong><\/span><\/p>\n"},"metadata":{"contentType":"Text","license":"U","title":"Untitled Text"},"subContentId":"960bdddb-e73f-4580-9172-6739d8cd821d"},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":4.357298474945534,"y":10.799136069114471,"width":88.23529411764706,"height":84.23326133909288,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":" \n\t Therapy is empirical - based on clinical and radiological features<\/li>\n\t Diagnostic uncertainty always remains <\/li>\n<\/ul>\n\n a) Until tissue confirmed using microbiological or histopathological examination<\/p>\n\n \n\t Expert recommendations \u2013 <\/strong><\/li>\n<\/ul>\n\n a) Duration \u2013 12-18 months of therapy may suffice \n - Lesion may persist after therapy; extended therapy beyond 18 months may not be required \n b) Imaging \u2013 repeat imaging may not be required unless clinically indicated \n - New onset seizures, neurological sign or symptoms<\/p>\n\n \n\t Response to therapy <\/strong>\u2013 based on clinical assessmen<\/li>\n\t No partial response implies<\/li>\n<\/ul>\n\n a) Fever persists; poor general well being; radiological worsening<\/p>\n"},"subContentId":"cc2ca853-7fc2-4769-b56c-b5d4acfba2db","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":6.490734341252699,"width":55.55555555555556,"height":8.639308855291576,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":" Tuberculoma & TB abscess <\/strong><\/span><\/p>\n"},"metadata":{"contentType":"Text","license":"U","title":"Untitled Text"},"subContentId":"31c28195-9623-420c-8de4-2893f7257c88"},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":5.443790849673203,"y":19.47781857451404,"width":49.01960784313726,"height":75.5939524838013,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":" \n\t In case of worsening features \u2013 clinical or radiological<\/li>\n\t IRIS \u2013 usually within 3-6 months of therapy<\/li>\n<\/ul>\n\n a) Short course of steroids may be added<\/p>\n\n \n\t Drug resistant TB<\/li>\n\t Other infectious causes <\/li>\n<\/ul>\n\n a) Neurocysticercosis, toxoplasmosis, \n b) Cryptococcomas<\/p>\n\n \n\t Malignancy \u2013 primary or metastatic <\/li>\n<\/ul>\n"},"subContentId":"bb925033-0509-446a-9fcc-4dd8e0b1bb5f","metadata":{"contentType":"Text","license":"U","title":"Untitled 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Management of CNS TB

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