[P3-22] Infantile Tuberculous meningitis complicated by West syndrome: Three cases
[Background]: West syndrome is characterized by triad of development delay, infantile spasm and hypsarrhythmia on electroencephalography. Tuberculous meningitis (TBM) is a rare cause of West syndrome. Three infants with TBM which got complicated with stroke and paradoxical tuberculomas and which later evolved to West syndrome are described here.
[Case History]: The children developed TBM at 3-10 months of age and were started on anti-Tubercular therapy and steroids. These children developed infantile spasms after mean period of 7.5 months(range 3-14 months). Repeat neuroimaging in the three cases showed conglomerate tuberculomas in one child and porencephaly and cystic encephalomalacia in the remaining two children. Two children were treated with Adrenocorticotropic hormone and the third child with oral corticosteroids. Spasms responded completely in two cases. All the three children however continued to have other seizure types for which they were treated with multiple anti-epileptic drugs. After follow up, two children showed improvement in developmental milestones (although they continued to have significant development delay)
[Discussion]: Infantile TBM is frequently complicated by progressive hydrocephalous and secondary neuronal injury, progressive meningo-vasculitis leading to infarcts, stroke and encephalomalacia and paradoxical tuberculoma as in these index cases. All three cases highlight the multifactorial origin wherein stroke, porencephaly and paradoxical tuberculoma contributed to the development of West Syndrome in TBM.
To conclude, Infantile TBM can have a protracted and complicated course with recurrent stroke and tuberculomas inspite of appropriate treatment, which can further be complicated by refractory epilepsy such as West syndrome.
[Case History]: The children developed TBM at 3-10 months of age and were started on anti-Tubercular therapy and steroids. These children developed infantile spasms after mean period of 7.5 months(range 3-14 months). Repeat neuroimaging in the three cases showed conglomerate tuberculomas in one child and porencephaly and cystic encephalomalacia in the remaining two children. Two children were treated with Adrenocorticotropic hormone and the third child with oral corticosteroids. Spasms responded completely in two cases. All the three children however continued to have other seizure types for which they were treated with multiple anti-epileptic drugs. After follow up, two children showed improvement in developmental milestones (although they continued to have significant development delay)
[Discussion]: Infantile TBM is frequently complicated by progressive hydrocephalous and secondary neuronal injury, progressive meningo-vasculitis leading to infarcts, stroke and encephalomalacia and paradoxical tuberculoma as in these index cases. All three cases highlight the multifactorial origin wherein stroke, porencephaly and paradoxical tuberculoma contributed to the development of West Syndrome in TBM.
To conclude, Infantile TBM can have a protracted and complicated course with recurrent stroke and tuberculomas inspite of appropriate treatment, which can further be complicated by refractory epilepsy such as West syndrome.