How does the presentation of tuberculous meningitis differ from acute bacterial meningitis?
Tuberculous meningitis is difficult to diagnose in its earliest stages as the symptoms tend to be nonspecific, mild to moderate in severity, and persistent (weeks).
Poor weight gain, low-grade fever, and listlessness may be seen in young children while older children may manifest headache and emesis.
As the disease progresses the symptoms become more severe with obtundation and evidence of meningeal irritation.
As tuberculosis tends to cause a basilar meningitis, cranial neuropathies are often seen in later stages.
Cerebrovascular disease with ischemic strokes is also seen—likely due to the proximal anterior circulation passing through the inflammatory infectious exudate.