Tuberculous meningitis pathophysiology
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Pathophysiology
Mycobacterium tuberculosis of the meninges is the most telling feature of tuberculous meningitis. Inflammation is concentrated towards the base of the brain. Infection begins in the lungs and may spread to the meninges by a variety of routes.
Blood-borne spread certainly occurs and 25% of patients with miliary TB have TB meningitis, presumably by crossing the blood-brain barrier[1]; but a proportion of patients may get TB meningitis from rupture of a cortical focus in the brain (a so-called Rich focus); an even smaller proportion get it from rupture of a bony focus in the spine. It is rare and unusual for TB of the spine to cause TB of the central nervous system, but isolated cases have been described.
References
- ↑ Jain SK, Paul-Satyaseela M, Lamichhane G; et al. (2006). "Mycobacterium tuberculosis invasion and traversal across an invitro human blood-brain barrier as a pathogenic mechanism for central nervous system tuberculosis". J Infect Dis. 193 (9): 1287&ndash, 95.