Brain Infections: Meningitis and Brain TB

Meningitis is an infection and swelling of the thin coverings of the brain and spinal cord. It can be caused by bacteria, viruses, fungi or tuberculosis (TB). Brain TB can cause TB meningitis or form a lump in the brain called a tuberculoma. Brain infections are serious, but most can be treated well when found early.

Symptoms

• Fever with severe headache
• Stiff neck, with pain when bending the head forward
• Vomiting
• Discomfort in bright light
• Confusion, drowsiness or unusual behaviour
• Fits (seizures)
• In brain TB, symptoms often come slowly over weeks: low-grade fever, weight loss, tiredness, a headache that keeps getting worse, double vision or squint, and weakness of the limbs
• In babies: high-pitched crying, poor feeding, unusual sleepiness or a bulging soft spot on the head

Causes

• Bacteria or viruses that spread from the nose, throat, ear or sinuses, or through the blood
• TB germs that spread to the brain from the lungs or another part of the body
• Close contact with a person who has active TB
• Weak immunity, for example due to uncontrolled diabetes, HIV, poor nutrition or long-term steroid use
• A head injury or previous brain surgery, in some cases

Diagnosis

The doctor examines the patient and may advise a lumbar puncture, in which a small amount of fluid is taken from the lower back with a thin needle and tested for infection. Blood tests, a chest X-ray and a CT or MRI scan of the brain with contrast help find the cause and look for problems such as brain swelling, a pus collection (abscess), a tuberculoma or a build-up of brain fluid (hydrocephalus).

Treatment

Most brain infections are treated with medicines, not surgery. Bacterial meningitis needs urgent antibiotics, usually given through a vein in hospital. Viral infections are treated with supportive care and, in some cases, antiviral medicines. Brain TB is treated with anti-TB treatment, which must be taken regularly for many months and should never be stopped early without the doctor's advice. Steroids may be given to reduce swelling, and anti-seizure medicines to control fits.

Neurosurgery is needed in some situations:

Hydrocephalus: TB meningitis can block the normal flow of brain fluid, causing pressure to rise. This may be treated with a thin tube (shunt) that drains the fluid to the abdomen, or, in selected patients, by an endoscopic procedure called endoscopic third ventriculostomy (ETV), which creates a new path for the fluid without a permanent tube.

Brain abscess or large tuberculoma: if a collection is large, pressing on the brain or not improving with medicines, it may be drained through a small hole in the skull or removed by surgery. A biopsy may also be done when the diagnosis is not clear.

When to Seek Urgent Care

• Fever with severe headache and stiff neck
• Confusion, drowsiness or difficulty waking up
• Fits (seizures)
• Repeated vomiting
• Sudden weakness, double vision or difficulty in speaking
• A sick, drowsy baby with fever or a bulging soft spot

If you notice these signs, go to the nearest emergency immediately.

If you or a family member is being treated for a brain infection and has worsening headache, fits or other concerns, you can consult Dr. Prashant Sharma at Keshav Super Speciality Hospital, Meerut, for a neurosurgical evaluation.

Related Conditions

• Headache
• Migraine
• Nerve Pain (Neuropathic Pain)
• Paralysis (Weakness of Limbs)
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