Unusual posture, with the head and neck arched backwards (opisthotonos)
Signs and tests
Physical examination will usually show:
Fast heart rate
Mental status changes
For any patient who is suspected of having meningitis, it is important to perform a lumbar puncture ("spinal tap"), in which spinal fluid (known as cerebrospinal fluid, or CSF) is collected for testing. When the health care provider suspects tuberculous meningitis, more than one CSF sample may be needed to make the diagnosis.
Treatment involves several antitubercular drugs at the same time, as it does for pulmonary tuberculosis. Treatment sometimes must begin if the diagnosis is only suspected, not proved, in order to save a person's life.
Treatment usually lasts for at least 12 months. Systemic steroids may also be used.
Tuberculous meningitis is life-threatening if untreated. Long-term follow-up is needed to detect repeated infections (recurrences).
David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, University of Washington School of Medicine; and Jatin M. Vyas, PhD, MD, Assistant Professor in Medicine, Harvard Medical School, Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.