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Complications - Hydrocephalus<\/strong><\/span><\/p>\n"},"subContentId":"cdbdb01d-b69d-4705-8eef-943666349607","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":4.3544662309368185,"y":10.816004319654429,"width":86.05664488017429,"height":86.39308855291577,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"

\n\t
Complication of Tb meningitis due to basal exudates: seen in > 50% cases<\/li>\n\t
Management includes - <\/li>\n<\/ul>\n\n
a) Medical - <\/strong><\/span>
\n 1. Steroids,
\n 2. Mannitol,
\n 3. Acetazolamide or Frusemide\u2013 may be used
\n
\n b) Surgical \u2013 <\/strong><\/span>
\n 1.Ventriculo-peritoneal shunt<\/strong>
\n - Indications - periventricular ooze; deteriorating sensorium; worsening hydrocephalus
\n
\n 2. External ventricular drain<\/strong>
\n - considered an acute intervention; bridge procedure till VP shunt is done
\n - When CSF protein is high (> 200mg\/DL)
\n
\n 3. Endoscopic 3rd ventriculostomy<\/p>\n"},"subContentId":"e28a5759-71a1-4cdb-b5b3-e3752533fa87","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":86.39308855291577,"width":37.03703703703704,"height":10.799136069114471,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
Goyal, 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":"269411dc-d3ca-4f84-9ca8-cff9ec8aedbb","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":46.84095860566449,"height":10.799136069114471,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
Complications - Raised intracranial pressure <\/strong><\/span><\/p>\n"},"subContentId":"e05eaf38-4b9c-4255-9f21-8078f25a31a7","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":86.05664488017429,"height":77.7537796976242,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
\n\t
Causes<\/strong><\/span><\/li>\n<\/ul>\n\n
a) Diffuse edema consequent to encephalitic process
\n b) Infarcts, micro and macro, secondary to vasculitis
\n c) Hydrocephalus
\n d) Space-occupying effect of associated tuberculomas<\/p>\n\n
\n\t
\n\t
Leads to decreased cerebral blood flow<\/strong><\/span> -> cerebral ischemia -> major contributor to poor outcome <\/p>\n\t<\/li>\n\t
\n\t
Osmotic agents <\/strong><\/span>- mannitol and hypertonic saline.<\/p>\n\t<\/li>\n\t
\n\t
Steroids <\/strong><\/span>\u2013 are the mainstay
\n\t
\n\ta) Intravenous dexamethasone, 4 mg every 6 hours<\/p>\n\t<\/li>\n<\/ul>\n"},"subContentId":"17e2c006-098f-49b4-b964-31d553289c08","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":46.84095860566449,"height":10.799136069114471,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
Other Complications <\/strong><\/span><\/p>\n"},"subContentId":"57942dc4-16b9-46cc-8c14-83b465681fb7","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":10.799136069114471,"width":91.50326797385621,"height":79.91360691144709,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
\n\t
Hyponatremia (Sodium <135 mmol\/L) -<\/strong><\/span> 40 to 50% patients of TBM <\/li>\n<\/ul>\n\n
a) 2 main causes \u2013 (i) SIADH (ii) Cerebral salt wasting syndrome
\n b) Manage according to \u2013 acute or chronic hyponatremia (48 hours)
\n c) 1. Fluid restriction, 2. Hypertonic saline, 3. Drugs \u2013 demeclocycline, vaptans<\/p>\n\n
\n\t
Seizures -<\/strong><\/span> > 30 % of adults with TBM<\/li>\n<\/ul>\n\n
a) Acute abortive treatment - benzodiazepines
\n b) Loading dose -> maintenance therapy: Levetiracetam, Phenytoin, Carbamazepine, Valproate<\/p>\n\n
\n\t
Vasculitis\/stroke: <\/strong><\/span> > 26-30 % <\/li>\n<\/ul>\n\n
a) Due to arteritis, arterial spasm, intraluminal thrombus, external compression of proximal vessels by
\n exudates in basal cisterns
\n b) Common sites: Anteromedial thalami & anterior limb & genu of internal capsule, head of
\n caudate nucleus<\/p>\n"},"subContentId":"19b34b45-e6db-4631-bfd7-a8d8cbf4203e","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":42.48366013071895,"y":84.23326133909288,"width":54.46623093681917,"height":15.11879049676026,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
Goyal, et al.: Treatment trends in CNS TB, AIAN 2019
\nMisra et al - Role of aspirin in tuberculous meningitis: A randomized open label placebo controlled trial- Journal of the neurological sciences ,2010<\/span><\/p>\n"},"subContentId":"49870586-bbf4-4442-9087-04fed1336e5f","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"}}

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Complications of CNS TB

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