Symptomatic therapy: Raised intracranial pressure- 20% Mannitol i.v 0.5 g/kg every 4-6 hr for maximum 6 doses. Convulsions-Diazepam i.v followed by phenytoin. Dyselectrolytemia-Maintenance fluids. Hydrocephalus and persistent decerebration-Ventriculocaval shunt.

1. S.Priyadharshini

2. Antitubercular therapy
Steroids
Symptomatic therapy

3.  The child is hospitalised preferably for first 2 months or until they are
clinically stabilized.
 Short course chemotherapy not recommended.
 Total duration is 12 months.
Initiation phase HRZE 2 months
Continuation phase HR 10 months

4. DRUGS DOSAGE
Isoniazid (H) 5 mg/kg/day
Rifampicin (R) 10 mg/kg/day
Pyrazinamide (Z) 30mg/kg/day
Ethambutol (E) 15-20mg/kg/day
Streptomycin (S) 30-40mg/kg/day

5.  In acute phase of illness, parenteral dexamethasone
(0.15mg/kg/dose) is given.
 Then switched over to oral prednisolone.
 Oral steroids continued for 6 weeks and tapered over
next 2 weeks.
 Rationale
Steroids reduce the intensity of cerebral edema,
arachnoiditis,fibrosis and spinal block.

6. Raised intracranial pressure- 20%
Mannitol i.v 0.5 g/kg every 4-6 hr for
maximum 6 doses.
Convulsions-Diazepam i.v followed by
phenytoin.
Dyselectrolytemia-Maintenance fluids.
Hydrocephalus and persistent
decerebration-Ventriculocaval shunt.

7. Intellectual
disability
Seizures Motor and cranial
nerve deficits

8. Hydrocephalus Optic atrophy Arachnoiditis

9. Subdural
effusion
Hyponatremia Tuberculoma

10.  BCG vaccination offers a protective effect (approx.64%)against TBM.
 Imporvement in weight for age was associated with decreased risk of
the disease.

11.  Poorer in younger children.
 Untreated cases die within 4-8 weeks
Stage Mortality Neurological deficits
Stage 1 Recovery -
Stage 2 20-25% 25% of survivors
Stage 3 50% All survivors

12. Duration of ATT is for 12 months
Indications for steroids in TB
TB Meningitis
Massive pleural effusions
Pericarditis and pericardial effusions
Presenting with hydrocephalus as a complication-suspect TB
Meningitis